@medman
Active 4 days, 17 hours agoForum Replies Created
-
Posts
-
-
Thanks Matt, this is a perfect example of what we see in practice improvement all the time. Your first line is:
“Trying to convince patient to exercise regularly and eat properly is a continuing challenge.”
Is that a problem or solution? It seems like a solution to me. What is the problem? Practice improvement, CPI and PDSA are designed to solve problems. Too often it is used to either justify a proposed solution. Convince patients to exercise and eat right is a solution to a problem. If patients did this they would improve their outcomes. What outcomes?
In this case we need to back up. What are you seeing in your practice that needs attention. Most practice improvement starts out as a perception. Like, it seems I am seeing more Type 2 diabetics, or more overweight patients, that ever before. My patients are all depressed because they hate their bodies. My practice has recently seen an upswing in orthopaedic injuries because all these people who suddenly gained a ton of weight went on ski vacations thinking they were 21 again. We are on a value based care contract and our episodes of care are killing us. I sit at lunch with my friends and they say don’t see the same thing in their practice. I wonder if I am doing something wrong. I pull the data. Are my perceptions supported by data. How am I doing vs. benchmarks? Now you have enough information to say, I have a problem and the degree of the problem is worth the time, energy, and resources to solve it. That is when you choose metrics to characterize the problem. Could be BMI, blood pressure, or cardiac stress test performance, or anything that represents the clinical condition of the patient subgroup in question. You get a team together of associates involved in those patient’s care. You brainstorm or brainwrite all the possible causes using the cause and effect tool, herringbone diagram. From here follow the CPI steps from the presentation and you will have a solution to test. Often times this process produces a different solution and more specific solution that “trying to convince them to take care of themselves better.
Great case Matt, I appreciate the opportunity to add my 2 cents.
-
This came to my email box from Matt Burday from Christiana, it is a great comment so I moved it here.
First the purpose of the meeting. Under 8 decisional, over 8 informational. Don’t workup decisions with large teams.
Most teams have decisional tasks and the way the meeting is conducted can be a value add or value minus. Formality is key. Agenda, on time, address the mission at the beginning of each, assignment of tasks either by the leader of facilitator, minutes, scheduling of the next meeting. Make sure the communication mechanism is agreeable. Don’t depend on email when everyone’s email box has a hundred entries every day, text message may be better. Consider rotating the facilitator so that everyone gets a chance, it will increase the engagement. Make sure there is equal participation. The leader needs to stay up on this because the power and participation of those on the team can migrate to strong personalities and you might lose the contribution of some others.
The team leader’s job is only to choose the team members, set the first meeting time, and the get a consensus on the rules. After that divide up the tasks, rotate the team responsibilities and don’t waste your team members time. You work it that way and you will become famous for your meetings, because no one in the organization will do it anywhere near as well as you.
Again, thanks for the thoughts and as leader of this class, I appreciate you time everytime you come on the site.
Check out the site you earned a sack full of credits, I posted leaderboards on all of the course pages.Take Care
Dave -
I’ve been pondering some questions to ask about meetings…the issue of assignments is of interest. I’ve brought this up locally before….having members work on things outside of the meetings monthly….to engage members..especially new ones…but I can’t seem to get this to happen. I think it would help committee members understand the mission better (now handed out at each meeting)….is it the responsibility of the person running the meeting to dole out assignments? Much of the time involves reporting about this or that, legal things going on in the State, etc…sometimes dull if one is not directly involved.
> Thanks Dave! Interested in your thoughts. -
We have been talking about the new leadership hire story at the local medical center. Things heated up this week with 2 candidates undergoing the interview process. My good friend called me an here is how here interview of the candidate went. Her and her colleague were told to be at a conference room at 9:30am for a 30 minute session. They both blocked 30 minutes, each had a patient starting at 10:00am.
They arrived 5 minutes early 9:25am and the COO and another “leader” were still talking to the candidate. The waited outside in the hall until 9:50 when the COO pushed them in and introduced them to the candidate. The candidate did most of the talking for the first 10 minutes. At 10am both physicians began to get anxious because they had patients waiting and a schedule now backing up. They finished at 10:20 and rushed back to see their patients 20 minutes late. The two physicians are not hospital employees and were not compensated for their time, the admin assumed it was their duty as medical staff members.
Lessons learned:
- The COO has little respect for providers time, running over into the physician’s interview time was a clear statement that his needs were more important than the physician”s and patient’s needs.
- It cost the physicians $300 ($600/hr rate of lost opportunity costs) each to participate in the interview.
Leaders should look out over the attendees of the meeting and calculate the lost opportunity costs of those attending. For some meetings that can be thousands. Then say to yourself, this meeting needs to be worth it and make every second count. We would have a lot less meetings and a lot more productivity and a clear message that leadership respects your time.
Both physicians came away from this interview thinking the COO had little respect for their time. Not good.
-
Throughout history, what happens when the ruling class becomes unresponsive to the needs of the working class? What happens when you feel your voice is not heard? First frustration followed by change. There are two things that catalyze change. First is a critical mass of the disaffected. The second is education to develop an understanding of how things work. As physicians we had a few handicaps. First, is that our rigorous education has taught us to a high tolerance level to just about everything. Second, the education curriculum is 100% focused on clinical knowledge. We have zero training in business process, that we learn from the street pretty much. If I were in a siloed environment the first thing I would do is promote a program like this to have my disaffected colleagues begin the thought process about how things should be. Then it begins with a democratic participatory meeting where everyone is asked to contribute and those contribution are valued by the group. Pretty soon you have a budgeting process that reflect the needs of providers and patients instead of being a slave to the silo. There will be obstacles all along the way, both people and process, but maintaining mission sensitivity, keeping patients in front as a shield to the siloed interests, then we will see change.
-
Great observation Irene. Here is my take. I understand that we all work under an organizational framework. I also know most organizations have a stated mission. I also know that most organizations are not mission sensitive. They rarely refer to mission in their decision making process. In this situation personal mission oversized corporate mission. I agree, the vast majority of physicians enter the occupation with a patient care driven mission. My experience is that over time this does not change much. They are always the ones to take the hit to make sure the patients receive good and safe care. Admin and corporate types, who have never seen a patient have other mission objectives and unfortunately it is to these people that we as physicians have outsources the work process. Shame on us, but as healthcare became more and more complicated we as physicians failed to keep up with skills that we needed. It is funny we are so compulsive about keep up with clinical skills. Yet we totally ignored the skills of resource allocation, finance, strategy, improvement and everything else that would actually help us care for patients in a sustainable manner.
It is not too late as you use your new skills for the forces of good and encourage others to join in with you. There is no excuse, all you need is a smartphone to join in the movement.
-
Welcome to the class. You have come to the right place. I was an OB/GYN at the end of my career looking for a change when I went to MBA at Johns Hopkins. All I can say is that I wished I had access to those skills coming out of residency. This program is a culmination of that MBA program distilled into the most practical. Great followup courses after you complete the Leadership program can be found on our core site. The COVID 19 Survival Kit is all about crisis management and business skills that address rapid change. Value Based Care examines practice efficiency using an activity based cost analysis method that is ideal for small practices. See the links below.
Thanks for joining the class!
-
Hi Vinod, welcome aboard. I appreciate your goals of growing your practice. This class is unique in that we just don’t talk about leadership as a title. We discuss it as an activity that requires skills never before presented to us in our training. Growing a practice requires strategy, finance, capital management, negotiation, and many of the other skills we cover here in this program at an MBA level. I shall take particular interest in following your progress and interacting with you along the way. Thanks for being here.
-
Hi Allen, part of what we do is respond to most if not all of the discussion comments. One thing for sure, we send a personalized welcome through the discussion board that you should receive as an email notification.
Here is yours. Welcome!
For selected members we have a special role “Group Leader” that will give you access to an activity dashboard where you can follow all of the progress of your residents that you introduce to the program including sending group emails and sharing case studies or other references with them as a group. Residents could also take advantage of the social media side of the platform and message each other to make friends or network.
If you have any questions let me know or write me back through the board.
-
Thanks Matt, this is a perfect example of what we see in practice improvement all the time. Your first line is:
“Trying to convince patient to exercise regularly and eat properly is a continuing challenge.”
Is that a problem or solution? It seems like a solution to me. What is the problem? Practice improvement, CPI and PDSA are designed to solve problems. Too often it is used to either justify a proposed solution. Convince patients to exercise and eat right is a solution to a problem. If patients did this they would improve their outcomes. What outcomes?
In this case we need to back up. What are you seeing in your practice that needs attention. Most practice improvement starts out as a perception. Like, it seems I am seeing more Type 2 diabetics, or more overweight patients, that ever before. My patients are all depressed because they hate their bodies. My practice has recently seen an upswing in orthopaedic injuries because all these people who suddenly gained a ton of weight went on ski vacations thinking they were 21 again. We are on a value based care contract and our episodes of care are killing us. I sit at lunch with my friends and they say don’t see the same thing in their practice. I wonder if I am doing something wrong. I pull the data. Are my perceptions supported by data. How am I doing vs. benchmarks? Now you have enough information to say, I have a problem and the degree of the problem is worth the time, energy, and resources to solve it. That is when you choose metrics to characterize the problem. Could be BMI, blood pressure, or cardiac stress test performance, or anything that represents the clinical condition of the patient subgroup in question. You get a team together of associates involved in those patient’s care. You brainstorm or brainwrite all the possible causes using the cause and effect tool, herringbone diagram. From here follow the CPI steps from the presentation and you will have a solution to test. Often times this process produces a different solution and more specific solution that “trying to convince them to take care of themselves better.
Great case Matt, I appreciate the opportunity to add my 2 cents.
-
I think that is why we are all here, to discuss access. I see a problem on both sides. Most physicians would not be able to make sense out of an income statement or even be fluent enough in finance to carry on an effective conversation. Words are important, just like in medicine.
Second, most financial information is kept away from the providers. This is counterproductive as the financial performance of your unit should be transparent. The first step in strategy is situational analysis. How can you make decisions when you know little about the finance. But then again, how many physicians do you know that practice good strategy planning.
It all comes back to education, not just for the selected few, but for all. Your institution says they have their own program in “leadership” and that covers business skill building. I bet the great majority of providers didn’t know this, if it is true and as accessible as it needs to be.
-
Thanks for the introduction Paul. It is great to have you with us. I am well familiar with Beebe. Mark Boytim from your joint center was in the last class we did with MSD. He actually has helped us with our patient education initiative. We have a vision of sending patients to class to educate them about their illness or condition or their wellness for that matter. We started with a course on Total Knee Replacement, on this platform, and Mark helped to review it and distribute it to Beebe Joint Replacement Center patients. Drew Brady from Christiana also is working with us. Long story short our course has 50 patient graduates, with learning and knowledge acquisition numbers off the charts. Lastly our mean survey score is 37.5/4o where 40 is the highest possible satisfaction.
These are 60 and 70 year olds getting educated at home or work, with the most common device being an iPhone/iPad. Who knew? If you have any interest in this project, let me know. In the meantime, thanks for coming to class.
Dave J
-
-
To be honest, that is what I thought about financial statements. After some practice I found I was pretty straight forward. The statement I use in the presentation is from a $600 million non profit hospital system. But when you get right down to it, the income statement is in the same form as every other income statement in the world. Revenues/expenses. Largest expenses at the top and smaller as you go down. Operating income tells you if you are losing money on your core mission. The operating margin can be compared to benchmarks to see if you are winning or losing compared to others. There may be a lot of other lines, investments, credit swaps, etc. but the core is the operating revenue and expenses. And then, as I said, benchmarks. As a leader you always want to know your position with respect to others in the industry. Have a handful of benchmarks available for what you may deem important data points. Follow this logic and you can have an informed presence in any board meeting. Before long they will have you running the thing.
-
Your BATNA is your most important negotiating tool. Let say all parties took this negotiation course. That just doesn’t mean you, it means the team that you represent. Your team does its homework and understands that the market has given you a weak BATNA. Let’s say opposing party also understands this as he or she did homework and understands the market. That person should also know the animosity created if you ground a poor BATNA situation into the opposing parties face. Does that person want a job where they got everything they wanted and then work with a bunch of people who hate him/her. That is a viable point, human nature should be ever present in any negotiation. At the end the with all the information on the table the decision becomes more informed. The best decisions arise when the most information is on the table. Of course you do not have to expose everything, you do not have to expose your BATNA. That is not relevant to the negotiation.
-
