Performance Excellence Simplified: Achieve Value Based Results

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Many hospitals face a challenge among key stakeholders. That challenge is a brand/reputation shift toward value based care. Mission, Vision and Values typically reflect claims of high quality and customer service, but key stakeholders (physicians, patients, families, employers, payers and regulatory bodies) are not buying the slogans of the past. In today's world, healthcare providers must demonstrate that they are living up to the value based equation (low cost, seamless, patient-centric, high quality care). Stakeholder demand and regulatory requirements drive organizations to demonstrate measurable results in cost, service and quality.

Creating a performance excellence environment is a highly successful leadership approach to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:


Engage your people: Develop Governance, Leadership and Management structures to engage your key players, especially physicians and other clinical thought leaders to lead the effort. Create a shared Vision of Achieving Value Based Results. Now it’s time to execute your shared Vision.


Evaluate your data; identify best practice: Engage all key players in identifying essential metrics to understand your current performance and identify opportunities for improvement in Operational/Financial, Service and Clinical performance.


Know your process and design your process (es): Utilize advanced process management methodologies to identify current processes that yield current results. Establish consistency in your process improvement methodology. Identify best practices. Design your processes to achieve results.

Hardwire/Standardize best practice, process design to ACHIEVE

Sustainable results will be achieved from your Action, if you are focused on Continuous Operating and Quality Improvement. Remember you may FAIL (“First Attempt In Learning”). Establish your culture of Performance Excellence. Start small, simplify, be resilient, be persistent and be unrelenting in your approach to achieving results. Be prepared to embrace “Polarity Thinking.” Every good conversation begins with good listening. Listen to your key stakeholders. Listen to understand, not to respond. Physician integration and value based strategies inherently present divergent opinions. Learn the power of leveraging Inquiry AND Advocacy: two critical leadership competencies. That’s how leaders achieve results.

Value Based Metrics:

The list of potential measures is endless. Identify what is important to your key players. Start with metrics that present and build a common understanding of current performance. Measure, monitor, report, analyse and improve your key metrics, focused on value: Operational/Financial Excellence, Service Excellence, and Clinical Excellence. A comprehensive list of potential metrics is available at: Mike Jones LinkedIn or This email address is being protected from spambots. You need JavaScript enabled to view it.

Key Takeaways:

  • You have highly engaged employees, physicians, patients, family members, community representatives, employers and payers.
  • You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
  • You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
  • You have measured your current performance
  • Now you want to improve performance:
  • Everything is a process

    Gain an understanding of your current processes

    Identify your best practices

    Design process to achieve best practice performance

    Re-evaluate your performance to see if you are consistently achieving improved performance

    Modify your processes when necessary to consistently achieve higher levels of performance

    Hard-wire your processes to ALWAYS achieve best practice performance

    Never stop monitoring to verify your preferred state performance/outcomes.

    Never stop monitoring to verify your preferred state performance/outcomes.

    Train for it (all Key Players)

    Build consistency of approach

  • Define your performance excellence culture
  • Focus your leadership on the relentless pursuit of performance excellence
  • Adopt your preferred methodology
  • Formalize and standardize your methodology
  • Listen to your key stakeholders
  • Engage all parties in understanding improvement initiatives
  • Gain understanding of performance through data analytics
  • Design processes to achieve desired results
  • Be prepared to Fail, but failing is your F (first), A (attempts), I (in), L (Learning).
  • Achieve success in all you do
  • Demonstrate that you are creating value based outcomes

Next Steps:

  • View Additional Reference Information:
    • In “Be an Inspirational Leader”, author Dan Nielsen portrays the incredible impact of inspirational leadership on your personal, professional, and organizational success. Read Dan Nielsen’s book: “Be An Inspirational Leader: Engage, Inspire, Empower”
    • Management of healthcare providers’ reputation and brand dramatically changes with consumer demand for value. An organization’s reputation is subject to more than marketing campaigns. Social media and ratings services have significant impact on consumer perception of healthcare organizations. If you do not have on-going audits of your on-line presences and ratings, it is wise to complete and assessment and take corrective action, as necessary. To learn more about Reputation and Brand Management view the work of Claire Faucett with engage5w.
    • Learn more about “Polarity Thinking” and the two essential leadership competencies of Inquiry and Advocacy. View the work of leadership coaches James McKenna and Cliff Kayser, sponsored by Wiederhold & Associates.
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Bad Bosses and Good Leaders

We are facing a critical era of transformation in healthcare. As organizations strategize to find stability through turbulent times, managers, directors, and executives will feel added pressure to achieve continuous, dynamic results.

The success of each department will depend on a single crucial factor: Is there a "boss" or a "leader" in place?

A "boss" refers to an individual who is in charge of the employee or an organization. He exercises control over employees, orders, assigns tasks and duties to them and is entitled to take decisions on some matters. Bad bosses will motivate through fear tactics, defer blame to others, take credit for other's successes and bully members into producing results.

The term "leader" is defined as an individual who possesses the ability to influence and inspire others towards the accomplishment of goals. Communication coupled with integrity compel people to follow. Great leaders think about what their body language, facial expressions, and tone of voice communicate to their staff. They often take the time to say things face-to-face rather than through email in order to build trust, develop relationships, manage conflict, and encourage employees. Leaders pull the best out of each member and inspire group success.

It is important to note that the teams which produce the most effective and long-lasting results are the ones that are directed by leaders, not bosses.

"If your actions inspire others to dream more, learn more, do more and become more, you are a leader." - John Quincy Adams

Transform Bosses into Leaders

Where bosses fail, leaders prevail. If you've noticed that you have more bosses than leaders in your organization- all is not lost. Aspiring and current managers, directors or executives can begin improving their ability to lead. Wiederhold and associates offer specialized assessments as well as a number of training programs designed to develop quality leaders that are custom fit to your organization. If you are interested in learning more, just let me know.

Here's to your success,

Jim

Connect with us on LinkedIn and join our Active Network Program.

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Process Management: Achieve Value-Based Results

“If you can’t describe what you are doing as a process, you don’t know what you are doing.” Such a profound quote by W. Edwards Deming, largely recognized as the Father of the Quality Movement. Dr. Deming's famous 14 Points, originally presented in Out of the Crisis, serve as management guidelines. The points cultivate a fertile soil in which a more efficient workplace, higher profits, and increased productivity may grow. These management principles have a direct correlation to navigating the path to achieving results in the uncertain healthcare industry of today.

Deming’s 14 Points for Leadership/Management

While traditionally applied to product manufacturing, Deming theory has direct application across multiple industries, especially when rising consumer and regulatory requirements demand greater value. View healthcare service delivery as a product in high demand from consumers (patients, families and others). Expectations of lower cost and superb quality, delivered in a highly patient-centric and service-oriented environment, create an imperative healthcare systems must meet to remain relevant.

    Healthcare leaders are served well when focusing on Deming’s 14 Points:
  1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive, to stay in business and to provide jobs.
  2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
  3. Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place.
  4. End the practice of awarding business on the basis of a price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
  5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
  6. Institute training on the job.
  7. Institute leadership (see Point 12 and Ch. 8 of Out of the Crisis). The aim of supervision should be to help people and machines and gadgets do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers
  8. Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of Out of the Crisis).
  9. Break down barriers between departments. People in research, design, sales, and production must work as a team in order to foresee problems of production and usage that may be encountered with the product or service.
  10. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
    1. Eliminate work standards (quotas) on the factory floor. Substitute with leadership.
    2. Eliminate management by objective. Eliminate management by numbers and numerical goals. Instead substitute with leadership.
  11. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
  12. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objectives (See Ch. 3 of Out of the Crisis).
  13. Institute a vigorous program of education and self-improvement.
  14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

The focus of this article is to bring home the reality that EVERYTHING IS A PROCESS. “If you cannot describe what you are doing as process, you do not know what you are doing.”

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care. Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

  • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
  • Service Excellence (service delivery exceeding patient and family expectations), and
  • Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” the organization will be led through:

  • Stakeholder Engagement
  • Knowledge Management/Knowledge Transfer
  • Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery. As highlighted in previous articles:

  • Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
  • Key Stakeholder Engagement is essential to execution of a common Vision:
    • Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
    • Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.
    • Knowledge Management/Knowledge Transfer
      • A common understanding of performance is best achieved through measuring, monitoring, reporting and analysis of key outcomes: Operational, Service and Clinical Metrics (Data Analytics) Here.
      • Opportunities for performance improvement are quickly identifiable when using data analytics in evaluating current outcomes.Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Performance Management. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of: Operational/Financial, Service, and Clinical Performance. Now you need a methodology to achieve your desired outcomes.

Physicians and other care providers work within a defined process everyday of their lives when addressing and resolving patient needs for care. What is done when presented with multiple patients with complex healthcare needs? SOAP is a traditional approach to addressing patient needs:

The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. The SOAP note originated from the Problem Oriented Medical Record (POMR), developed by Lawrence Weed, MD.[1] It was initially developed for physicians, who at the time, were the only health care providers allowed to write in a medical record. Today, it is widely adopted as a communication tool between inter-disciplinary healthcare providers as a way to document a patient’s progress. SOAP notes are now commonly found in electronic medical records (EMR) and are used by providers of various backgrounds. Prehospital care providers such as EMTs may use the same format to communicate patient information to emergency department clinicians. Physicians, physician assistants, nurse practitioners, pharmacists, podiatrists, chiropractors, acupuncturists, occupational therapists, physical therapists, school psychologists, speech-language pathologists, certified athletic trainers (ATC), sports therapists, occupational therapists, among other providers use this format for the patient's initial visit and to monitor progress during follow-up care.

It is a well-defined thought process. Complete a SUBJECTIVE EVALUATION, an OBJECTIVE EVALUATION, an ASSESSMENT and a PLAN. Engage patients and family members when seeking to understand what is happening with a patient (Subjective). Gather facts/data regarding what is happening with a patient through diagnostic procedures (Objective). Review the information gathered and knowledge gained from the evaluations (Assessment) and take action to address what has been presented (Plan). Why not apply a similar process that is highly effective to leadership and management. That is a process management/performance management approach.

Performance Management

The days of simply making claims of high-quality, service-oriented and low cost care delivery are gone. Patients, families, communities, payers, regulatory agencies and other key stakeholders demand proof of performance. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. Once you understand current performance through data analytics, you need tools to achieve continuous improvement.

There are many theories of performance/process management. Theories and practices have evolved over time. Many are inter-related and draw on common practices. Process Management philosophies include, but are not limited to:

  • Total Quality Management (TQM):
    • Focus on the Consumer
    • Continuous Improvement
    • Quality Improvement
    • Accurate Evaluation
  • Continuous Quality Improvement (CQI):
    • Analyse
    • Refine
    • Improve
  • Plan Do Study Act (PDSA): Model for Improvement: What are we trying to accomplish? How will we know that a change in an improvement? What change can we make that will result in improvement?
    • Plan: Objective, Questions and Predictions, Plan to carry out the cycle (who, what, where, when)
    • Do: Carry out the plan. Document problems and unexpected observations. Begin data analysis.
    • Study: Complete the data analytics. Compare data to predictions. Summarize what you have learned.
    • Act: What changes are to be made? Begin the next cycle.
  • Lean Management:
    • Leadership Commitment to Project (s)
    • Project Charter (Standardized for ease of understanding).
    • Project Tracking (verify milestones)
    • Assign Project Manager
    • Engage Key Stakeholders
    • Communicate Frequently
    • Achieve Results
  • Lean:
    • Waste Reduction
    • Continuous Improvement
    • Respect for People
  • Six Sigma-DMAIC:
    • Define: Define project purpose and scope. Identify high level processes for improvement. Determine customer needs and benefits.
    • Measure: Baseline data on current processes. Pinpoint problem locations and occurrences. Identify potential areas for improvement.
    • Analyse: Identify root causes and validate root causes against captured data. Determine improvements that need to be made.
    • Improve: Implement the improvements that have been determined to address the root causes.
    • Control: Perform before and after analysis. Monitor processes/systems. Document results. Determine next steps/recommendations.
  • Lean/Six Sigma:
    • Lean: focuses on waste reduction by streamlining process
    • Six Sigma: focuses on preventing defects through problem solving
    • Lean/Six Sigma: Lean strengthens Six Sigma-Problem solving plus improving process delivers greater value-based results

The common thread in all methodologies is an unrelenting focus on seeking improved outcomes in everything we do:

  • Cycles of improvement
    • Engaging in a customer focus
    • Understanding key stakeholder perspective
    • Measuring current performance through data analytics
    • Engaging those closest to the work:
      • to define current processes (value stream mapping, flowcharting)
      • to define desired outcomes of current processes
      • to define undesirable outcomes (failures) of current process
      • identify and define best practices
      • identify and define outcomes
      • identify and define preferred processes to achieve best practice performance and outcomes
      • transfer best practices, best practice outcomes and preferred processes to:
        • gain consistency across all players
        • reduce variation in outcomes and results across all players
        • meet and exceed customer expectations at all times
        • reduce cost of service delivery
        • increase throughput in service delivery
        • provide consistent, high-quality outcomes

Performance Management Simplified

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Creating a performance excellence environment is the best to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:


Engage your People


Evaluate your data; identify best practice


Know your process and design your process

Hardwire/Standardize best practice, process design to ACHIEVE

Key Take Aways:

  • You have highly engaged employees, physicians, patients, family members, community representatives and payers.
  • You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
  • You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
  • You have measured your current performance
  • Now you want to improve performance:
    • Everything is a process
    • Gain an understanding of your current processes
    • Identify your best practices
    • Design process to achieve best practice performance
    • Re-evaluate your performance to see if you are consistently achieving improved performance
    • Modify your processes when necessary to consistently achieve higher levels of performance
    • Hard-wire your processes to ALWAYS achieve best practice performance
    • Never stop monitoring to verify your preferred state performance/outcomes.
    • Pick a methodology for process management (they all work)
    • Train for it
    • Build consistency of approach

Next Steps:

  • Define your performance excellence culture
  • Relentless leadership focus on performance excellence
  • Adopt your preferred methodology
  • Formalize and standardize your methodology
  • Listen to your key stakeholders
  • Engage all parties in understanding improvement initiatives
  • Gain understanding of performance through data analytics
  • Design processes to achieve desired results
  • Achieve success in all you do
  • Demonstrate that you are creating value based outcomes
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Enhanced Regional Referral

The Problem – Across the nation, health systems are reporting a sustained decline in Emergency Department utilization, resulting in decreased admission rates and reduced patient days. Regardless of the cause (Healthcare Reform, economic challenges, rising unemployment, etc.), the impact is clear – an average 3-5% drop in census and a significant loss of revenue.

The Emergency Department Imperative – On average, 12-15% of Emergency Department visits result in patients being admitted, which accounts for approximately 40-50% of a facility’s total admissions, and a contribution margin between $1k - $15k per admit. The direct connection between Emergency Department utilization, subsequent admissions and the resulting revenue indicates that the success of any facility in this changing healthcare landscape depends on increasing the number of times that new patients pass through the Emergency Department doors. Health systems operating Trauma Centers will have contribution margins exceeding the national average.

The Million Dollar Question – Understanding the concept of countering a declining census by increasing Emergency Department utilization is easy, but successfully operationalizing that strategy may not be. Simply put, how does one hospital or health system get more patients into their Emergency Departments than another? Although there are many potential answers to that question, experience shows that the most effective solution is for a facility or health system to develop a highly functional Regional Referral Program.

The Regional Referral Solution – Health systems should be able to successfully capitalize on its current Trauma status and market itself as regional destination, which will significantly increase patient admissions. A key to success will be aligning referring facilities, physicians, and transport providers through an efficient Transfer Center operation. Your organization will be able to benefit from those opportunities. Additionally, current successes show that facilities and health systems that have implemented Regional Referral Programs have grown their influence significantly garnering patient care and admission opportunities from facilities far outside of traditional referral patterns. This has proven beneficial because the payor mix of patients being referred from out-of-area tend to be equal to or better than the receiving facility’s current Emergency Department mix, resulting in a 15 to 1 return on investment.

Regional Referral Program Priorities – Numerous successful hospitals and health systems have developed very effective Regional Referral Programs by prioritizing the following:

Identification and Development of Key Service Lines – Determining which specialties (Trauma, Cardiology, Neurology, Pediatrics, etc.) the facility wishes to specifically solicit patients for. The goal is to develop a solid reputation as the “go to” receiving facility for the targeted service lines.

Aligning Physician Partners – The success of any Regional Referral Program depends on the participation and support of the facility’s physician partners, whether by promoting the program with regular visits to the region’s referring facilities, or by being consistently available and accepting patients. To achieve this, successful Regional Referral Programs have implemented effective Hospitalist Programs to receive the patients and specialist compensation programs that reward participation.

Transfer Center Utilization and Marketing – Effective Regional Referral Programs require three primary components; necessary specialties, physician participation, and a simple, consistent way for facilities to refer their patients. Structured Transfer Centers tie the entire referral program together with “one call does it all” ease, coordinating patient transfers from the initial request through completion of the transport. Mature Transfer Centers will also provide extensive operational reporting and key patient flow analytics for hospital administration. Focused marketing strategies can also convert the Transfer Center from a passive patient flow processing service into an aggressive volume builder for the facility or health system. Proven techniques can be employed to grow desired business through sound relationships with the referring parties.

Note: There are generally two methods of implementing a Transfer Center service; a facility can develop the service in-house or they can seek out a professional third-party Transfer Center service provider. An internal Transfer Center allows the facility or health system to maintain strict control of the staffing, customer interactions and processes, but a professional external Transfer Center will generally provide outstanding service delivery at a fraction of the cost.

Regional Referral programs are showing exceptional returns in the form of increased Contribution Margins per referral. The chart below – based on actual Regional Referral Programs – highlights the benefits:

Transfer Center Costs – Studies of current successful internal Transfer Center services show that the average cost per transfer request is approximately $230 for new centers and $190 for established centers (assuming a daily request volume of ~12). For facilities or health systems that prefer to forego the expense and coordination of operating their own Transfer Centers in favor of utilizing the expertise of a professional external service, the cost is obviously significantly lower – with no associated reduction in the contribution margin per transferred patient.

Conclusion – For hospitals or health systems seeking to counter the downward trend in Emergency Department utilization and subsequent census declines, it is essential that they develop a Regional Referral Program. By establishing themselves as “centers of excellence” in key service lines, partnering with their physician specialists, and easily facilitating patient flow through efficient Transfer Centers, facilities can continue to thrive even in today’s constantly shifting healthcare environment.

Solution - We can provide a comprehensive assessment of the opportunity for your organization to expand your market as a Regional Referral Center with a state of the art Transfer Center.

✔ Current situation
✔ Market potential for referrals
✔ Business plan for the recommended approach with a Return on Investment analysis
✔ Sensitive issues
✔ Hospital capacity readiness
✔ Medical Staff readiness
✔ Hospitalist Program effectiveness
✔ Case management strategies
✔ Nursing coordination
✔ Administrative and Medical Leadership buy-in

Please let us know if you would like to explore the assessment of the potential for your health system. We look forward to possibly assisting you with this important project.

Thank you,

This email address is being protected from spambots. You need JavaScript enabled to view it.

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Leadership Key: Impact Conversations

By Joy W. Goldman | Leadership Coaching

In the March, 2017 newsletter, I introduced the topic of trust and highlighted five ways leaders increase trust in their organizations. Today, I wanted to provide an overview of two very practical tools that can be used to engender trust in ALL relationships, regardless of how challenging you may find some to be:

Conversational Intelligence and Polarity Thinking

You can deepen your learning on Polarities during an upcoming Wiederhold & Associates webinar on Aug 1.

Wiederhold & Associates Webinar
August 1, 2017 - "Polarity Thinking"

Register ASAP to obtain needed pre-work for this interactive webinar

Click to pay Registration Fee

No Fee For Premium Active Network Members and current clients.

For more information contact This email address is being protected from spambots. You need JavaScript enabled to view it.

Judith Glaser in her book, Conversational Intelligence, asserts that ALL work is conducted through conversations. Think about it! Is there anything you do that does not involve a conversation? From a pure productivity perspective, think about the time you could save if most of your conversations were impactful.

During July’s webinar, Cliff Kayser and James McKenna, two phenomenal executive coaches, illustrated in their usual humorous way, one element of effective conversations: The power of leveraging Inquiry AND Advocacy: two critical leadership competencies. The May/June 2017 issue of Harvard Business Review included an article that talked about four key attributes that distinguished high performing CEOs: the ability to be decisive was one of them. As a leader, “telling,” and “advocacy” is essential in certain circumstances.

The most powerful leaders know how to leverage advocacy AND inquiry, and they know when they’re being effective, and when they risk derailment. Signs of an overuse of advocacy may include noticing that they are doing most of the talking and others aren’t offering their opinions; leaders may notice that their audience seems less engaged. In the extreme, they may also notice that not too many people are following them!

Glaser’s levels I and II conversations consist of “telling,” or using questions that are geared toward eliciting what the leader already knows to be true. They are using inquiry but only with a goal to validate their own thinking. Glaser discusses the more powerful level III conversation that is focused on “Sharing And Discovery.” Level III conversations ask questions for which the leader doesn’t know the answer to the question.

    Sample discovery questions include:
  1. Sample discovery questions include:
  2. What matters most to you right now?
  3. To resolve this conflict successfully, what would need to occur for you?
  4. Tell me what I might not be seeing or understanding right now?
  5. If we couldn’t fail, what would we be doing right now?
  6. If we could better leverage Safety AND Risk, how might we better serve our customers/ community?

When leaders ask questions that come from a place of curiosity, we tap into our audience’s prefrontal cortex and quiet their amygdala, the primitive part of our brain, which kicks into high gear when we feel threatened. Creativity and trust come from our prefrontal cortex: through sharing and discovery conversations.

In healthcare, our habit is to look for problems. Simple problems often have a right or wrong answer. Complex problems/ situations rarely do and are better served by leveraging interdependent tensions or pairs: polarities. Come to the webinar in August to learn more about leveraging Inquiry AND Advocacy.

    In future newsletters, we’ll also explore other healthcare tensions like:
  • Mission AND Margin
  • Confidence AND Humility
  • Centralization AND Decentralization
  • Standardization AND Customization

I look forward to our next conversation!

Joy W. Goldman RN, MS, PCC, PDC
Executive Director, Leadership Coaching
Wiederhold & Associates

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Target Success with Advanced Networking Strategies

Because you've been a part of the Wiederhold & Associates Network, we wanted to share some exciting news with you first.

As you know, networking/connecting is essential to your success both while in transition and gainfully employed. Networking with a purpose is a vital component of anybody's career success but is often terribly neglected. Being intentional is necessary.

Therefore, we have formalized a streamlined process to make it easier for you to expand your network through Wiederhold Intentional Networking (WIN) program. Becoming an active WIN participant will enable you to:

  • With limited effort, expand your own network with quality connections
  • Exchange key information about market and industry trends
  • Increase ability for quality transitions through network connections
  • Affect others in a positive way
Are You Ready to WIN?

The WIN strategy gathers key information from each premium active network member and targets meaningful matches within our client list. As an active member in our program, W&A will introduce you to key members of our current network, helping you gain significant connections that you would not otherwise have access to. Remember, most of our clients are Vice President through C-level executives.

Once you have made the connection, we will send you a short anonymous evaluation form. Each member's feedback will bring value to helping our clients grow their skills in effective networking/connecting as well as passing along current industry trends.

If you want to know more about expanding your network with little effort while affecting others in a positive way, contact This email address is being protected from spambots. You need JavaScript enabled to view it. and she will let me know of your interest and follow up.

Here's to your success!

Jim

Connect with us on LinkedIn and join our Active Network Program.

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Goal Setting: Preventable Patient Harm – 'Target Zero?'

During a recent goal-setting cycle, I worked on setting reasonable, although loftier, strategic goal metrics due to significant LEAN expert resourcing for my management team to focus on making transformative leaps in process improvements rather than small, incremental changes. In analyzing the strategic goal area of preventable patient harm, the Patient Safety Composite observed to expected ratio baseline was 0.629. A ratio above 1 is undesirable and a ratio below 1.0 is highly desirable. So, 0.629 is excellent, correct? Instead of improving the stretch goal by 5%, we considered 10% improvement. That is stretch goal, chest pounding, we are doing a fantastic job material!

Amid this goal setting, I was at the beach watching the news and drinking a cup of coffee readying myself for a day of fellowship, bocce ball, and sun. The local station in Myrtle Beach, SC ran a story with some interviews regarding the Target Zero – South Carolina’s Highway Safety Plan 2015 -2018. The plan was developed by the SC Departments of Public Safety and Transportation with many stakeholders including the SC Highway Patrol.

At the time, South Carolina’s 5-year average highway mortalities were ~800 per year. Immediately, I thought what an audacious goal considering they do not have control of every aspect of the events – human error, human disregard for rules, or processes/design flaws/mechanical failures. Think about this strategy compared to preventable patient harm with a Just Culture mindset as illustrated below:

If South Carolina is setting a target of zero highway fatalities, what is preventing me/us from setting a target of zero for preventable patient harm? The way we analyze data with observed to expected ratios with results below 1.0 informs us we are doing better than expected and inadvertently depersonalizes this issue. At 0.629, we were knocking it out of the park. At the end of the day, it is about perspective. The interviews shown on the newscast drove this point home for me. The interviewers asked residents around South Carolina two separate questions regarding goal setting for decreasing highway fatalities. Please view the video for about 2 minutes (from WMBF News in Myrtle Beach, SC) here.

Again, the Patient Safety Composite observed to expected results of 0.629 were fantastic! Well, not for the 53 patients harmed that we, as an industry, deem to be preventable. So, how will you set future goals and allocate resources to achieving those goals? Are small incremental improvements satisfactory or do we look to transform our thinking, people, and processes to achieve Target Zero for Preventable Patient Harm?

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Building and Repairing your Online Reputation

The Internet has changed the game for job seekers. The paper resume has been swapped out for a LinkedIn profile. Face-to-face meetings have been replaced with Facetime. Your local word-of-mouth reputation is small potatoes next to someone with a well-developed online presence. When it comes to the Internet, you are who Google says you are.

Fact: 92 percent of recruiters “Google” potential candidates according to a social recruiting survey. LinkedIn is the clear favorite, with 94 percent of recruiters searching it to find top talent. Potential employers also look at Facebook, Twitter, Google+ and really anything that search engines render when your name is entered.

Can you take control of your online reputation?

Be Informed. Monitor your personal brand. The first step in protecting and building your online brand is by knowing what is being said or has already been said. It’s impossible to control everything that is written about you, but even though you can’t always control what is published, you can at least know and respond to it.

Monitoring your personal brand is a two-step process. First, you figure out what is being communicated around your personal brand currently. Second, create a positive plan to improve it, build upon it.

Easy ways to monitor your reputation online:

  • Google Yourself – do this at least once a month. Look for your name not only in the search results, but also the image search, news search, and video search.
  • Create Google News Alerts containing your name. You can find this screen under google alerts. Note: you will have to establish a Gmail address.

How to repair and build your online reputation:

You’ve Googled yourself and found that there is at least one article that really gets in your craw. Perhaps it’s misleading, a lie, or just not flattering, and it is published on a website you have absolutely no control over. You want to wave your magic wand and just make it disappear. What can be done?

1) Get legal involved. You may have a case if:

  • Defamation has occurred. For instance, someone has published a false statement that is damaging to the company or person.
  • Google will remove links from search results when presented with a court order, even though they’re not legally required to do so. (Internet publishers of third-party materials may not be required to remove links, unlike offline publishers.)
  • Legal action will come at a high price, on average $5,000-$10,000 per article and may not work.

2) Create and publish online through news publications and social media platforms such as LinkedIn. This is the most effective way to rid yourself of unwanted search results over time. How it works: Say you have a negative news article you want to push off the front page of the Google search results. The more content you publish with your name mentioned the more likely positive search results will be rendered when your name is searched. It should be noted that it takes time to push negative articles down the list and off the first page of results. This is due to a number of complicated algorithm factors, all dependent on Google’s rules surrounding credible content. For example, it will be much easier to bury an article posted by a local or regional paper than it would an article or video posted on CNN. Reason being is that the more credible or popular the site is, the more weight Google gives it. So your goal should be to match or overtake the negative article with your original content published on equally credible sites.

Key Take-Aways

  • Always be aware of what is being said about you online. If nothing is being said, you are uniquely positioned to create a positive online reputation by populating the Internet with content and online profiles where you are in full control of the message.
  • If you do have a negative online reputation, it’s never too late to start the repair process. Ignoring it won’t make those links disappear and the problem will still exist five years from now. Better to take the time now to start rebuilding your presence online.

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Wiederhold & Associates remembers our fallen on Memorial Day

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Achieve Value-based Results in Healthcare: Knowledge Management/Transfer Through Data Analytics

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

  • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
  • Service Excellence (service delivery exceeding patient and family expectations), and
  • Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” organization will be led through:

  • Stakeholder Engagement
  • Knowledge Management/Knowledge Transfer
  • Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery.

As highlighted in previous articles:

  • Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
  • Key Stakeholder Engagement is essential to execution of a common Vision:
    • Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
    • Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Knowledge Management/Knowledge Transfer. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of:

  • Operational/Financial Performance,
  • Service Performance, and
  • Clinical Performance.

Knowledge Management/Knowledge Transfer Through Data Analytics

The days of making claims of high-quality, service oriented and low cost care delivery are gone. Regulatory requirements and consumers of healthcare demand demonstrated proof. On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is intended to improve Medicare by helping you focus on care quality and focusing on making patients healthier (population health management). The Quality Payment Program’s purpose is to provide new tools and resources to help organizations to provide patients with the best possible, highest-value care. The Quality Payment Program has two tracks to choose from:

  • The Merit-based Incentive Payment System (MIPS), and
  • Advanced Alternative Payment Models (APMs).

Healthcare providers are required and must report key measures of performance in order to maintain a competitive edge and to maximize reimbursement for services rendered. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. The best place to start is to define your measures, based on industry standards. Engaging your Governance, Leadership and Management representatives, as well as other key stakeholders, in defining performance metrics is essential to gain a common understanding. Begin by gathering potential sources of industry standards (see table).

Knowledge Management/Knowledge Transfer Process:

The quest for appropriate data analytics to measure, monitor, report, analyze, improve and control can be challenging. Once sources of industry standards have been identified, engage stakeholders in organization-wide effort to define your measures of Operational, Service and Clinical metrics:

  • Review and select meaningful measures:
  • Verify the organizational capacity to measure, monitor and report measures:
    • Be sure all metrics of performance are measurable.
    • Operational and Financial Metrics are typically readily available, but may not be reported in an intuitive format with full-transparency across the organization and among key stakeholders.
    • Service Metrics (patient engagement) should be standardized using a formal survey tool, administered by a vendor approved for use by The Centers for Medicare & Medicaid Services (CMS).
    • Measures of Clinical Performance may present the greatest challenge:
      • While sources of key measures are readily available, the ability to measure performance across all providers may be limited.
      • Desperate systems in multiple healthcare settings increase complexity of data collection.
      • Clinical information may be captured as free form text and may require manual/human intervention for interpretation.
      • Manual data abstraction may present a high cost alternative to automated reporting.
      • Lack of interoperability of information systems creates complexity.
      • Clinical and claims data are not typically consolidated.
      • The good news is: multiple vendors are available with advanced tools to aggregate data to support your efforts to measure, monitor, report, analyze, improve and control clinical performance.

  • If necessary, select reliable vendors to provide external support for the purposes of understanding measurable performance.
  • Create detailed analytics reports across the organization at the Enterprise, Specialty, Practice Location and Individual Provider levels,
  • Determine baseline performance at all levels,
  • Set routine reporting intervals (daily, weekly, monthly, quarterly and annually), as appropriate,
  • Set levels of performance:
    • minimum level of performance,
    • expected/goal level of performance, and
    • Level of performance exceeding goal.
  • Utilize high level dashboard reporting tools for ease of review and understanding across the organization:
    • A simple “stop light analysis” provides ease of review (see below):

    Click here for Reference Sources.
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    A Strategic Nursing Career

    What would it take to build your career strategically?

    Nursing Leaders think strategically about the work they do, often considering the needs of their organizations, their staffs, and the patients they care for as their primary focus of their careers. Rarely, however, do they spend much time thinking about a personal strategy for their own careers.

    Have you considered what you want for the next chapter of your career?

    If you are in the middle of your leadership career or heading to the end of traditional employment, making the next phase of your career the most intentional and thoughtful of your life is within your reach. At Wiederhold and Associates, we have witnessed the tremendous outreach nursing leaders can have when they take their careers to the next level. Be it within the same position, or a new direction, the strategic career does not wait for opportunities to come along.

    Strategic careers are often designed and created by individuals who have developed shifts in thinking that utilize an increased awareness of themselves to confidently self-determine their offerings and value. Learning to communicate that value to others is a key part of the strategy.

    A personal career strategy is not a selfish endeavor. When a nursing leader combines passions, talents (or potential talents) with intention, many lives and careers can be changed for the better. It could be the most important work of your life.

    Taking stock of new or unrealized potential is the work of our organization as we expertly coach leaders to understand their career trajectory and make self-determination strategic goals for the most optimal work experiences. We have been honored to work with great leaders and assisting them to achieve their potential is some of the most important work we do.

    As an experienced consultant in strategic and transformational change, Diane has an extensive background in helping leaders develop and succeed. Her healthcare experience spans three decades as a healthcare administrator, clinician, and graduate school educator. To learn more, click here.

    Connect with us on LinkedIn and join our Active Network Program.

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    Strengthening Our Nation’s Healthcare Leadership

    Wiederhold and Associates is partnering with Yaffe & Company to host a series of discussions with select healthcare leaders across the country to examine the issue of executive recruitment, retention and leadership development. The gatherings will take place in cities such as Dallas and Houston, Denver, Chicago, San Francisco, Philadelphia, and New York, offering an opportunity for top-level executives and state hospital associations to network and share their opinions.

    Do We Need a Treatment Plan?

    The CEOs and other high-level executives who run our nation’s healthcare institutions form an important framework of our entire system. In recent years, a maze of migration has formed: in major urban markets, as well as outlying areas, these executives are coming and going from one position to the other, more often than ever. Sometimes, this happens for legitimate reasons. But all too often, it occurs because of a hiring mismatch, or misunderstandings between the board and the executive team, or some other reason that may have been avoided. The effect on our nation’s healthcare organizations, combined with the lack of viable succession plans in many institutions, is costly.

    How much better off would we be if we could strengthen our country’s healthcare leadership overall? Imagine a system where many more of our healthcare executives are finding their best personal fit, and functioning in the places and positions where they are most likely to be successful. This series addresses these issues and opens the floor for candid discussion among our nation's top executives in the healthcare industry.

    While we are only able to invite a select group of individuals as space is limited, we do want to hear your thoughts on the above issues. Please complete this survey or contact This email address is being protected from spambots. You need JavaScript enabled to view it..

    Jim

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    Best career advice- “Play Hungry Hungry Hippos”

    Remember that game, “Hungry Hungry Hippos”? It’s simple - s/he who collects the most marbles, wins. If you want to maximize your career opportunities, you must play this game well. How do you win? You must pocket as many network connections (marbles) as possible. 80% of jobs are found through networking (not online job boards). The more people you connect with, the more people you’ll connect with as networking has a compounding effect. This leads to opportunities.

    It’s not just about talking with people- you must connect with them. Be inquisitive, learn about them personally and professionally. Find connection points between the two of you. Once people genuinely like you, they are more apt to help you. And, don’t forget to concisely communicate your brand (or calling card, value proposition, what you’re known for). Once they know your value (turnaround king, patient satisfaction guru, etc.) they can help connect you with organizations who have these needs.

    Once you pocket these connections, take care of them. Help them every chance you get- don’t always make it about you. Help them solve problems, introduce them to others, listen, and always follow up.

    Be like the hippo - pocket network connections and take care of them!

    Connect with us on LinkedIn and join our Active Network Program.

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    The Discipline of Project Management

    In this time of rapid transformation of care delivery, financing and business models, successful project management is more critical than ever. Whether a major facility or IT project or operational projects such as new staffing models, population health initiatives or business process enhancements, projects of all types benefit from project and change management expertise. Well run projects have a far greater chance of coming in on time and on budget. Organizations with high-performing projects realize project success more than twice as often as do their counterparts with low-performing project management.

    Successful projects share several key elements, including: committed, supportive leadership, a clear definition of success, trained project management professionals to drive change through each phase of the project and engaged and informed stakeholders who will support and adopt the changes associated with the project.

    What do these critical factors mean for a typical healthcare organization?

    Leadership

    The role of leadership cannot be under-estimated. Studies have shown a direct correlation between senior leadership engagement and project success. Senior leadership commissions the project and approves the project charter. In addition, senior leadership engagement is critical throughout the lifecycle of the project: as champion for the project, in active monitoring of its progress, taking decisive action when issues are escalated and removing roadblocks that are beyond the influence of the project team.

    Project Charter

    A well-crafted project charter provides the framework for the project: its scope, the strategic and business objectives to be achieved and timelines. It identifies the stakeholders to be considered and involved. A well-crafted charter provides the basis for the project plan. Equally important, the project charter establishes what is out of scope which provides focus for the project team, creates clear expectations of the project and prevents scope creep.

    Professional Project Management

    All managers are responsible for managing projects. But, not all projects are alike. Nor are all project managers. Some managers naturally bring the change, time and project management skills needed to lead a project. However, even the most naturally gifted can benefit from project management training. The more complex the project, the greater the need for trained, experienced project managers. The number of disciplines and departments involved, the degree of transformation required, the criticality of timing, the need for IT changes and the cost of the project are all considerations in determining the type of project manager best suited for the project.

    Stakeholder Engagement and Change Management

    Too often, projects are de-railed due to lack of key stakeholder engagement, understanding and adoption. The discipline of project management includes a thorough assessment of stakeholders impacted by the project, their needs and the best means of engagement. This assessment combined with time tested change management processes improves the level of stakeholder understanding, participation and adoption to ensure that project goals and outcomes are achieved. Stakeholder engagement is a critical investment in long term project success that cannot be over-looked.

    Where to turn for assistance

    There is an array of resources available to establish the discipline of project management throughout an organization, both internal and external. For organizations with an Enterprise Project Management Office (EPMO), internal project management experts can be tapped to provide training and resources for their non-EPMO project management colleagues. Training programs that offer project management certifications are a rich source of education. Local chapters of these organizations, colleges or other community organizations are also a good for source of training and networking. Independent project management consultants can offer an array of project management resources to support an organization’s needs, both educational and contract project management. Any combination of these resources can fill gaps while an organization builds the internal project management competency and infrastructure to ensure the success of projects throughout the organization.

    These fundamental steps lead to a greater discipline in managing projects, minimize risk and create a culture that can effectively manage the innovation and change required for future success.

    Theresa Lewis
    Practice Management Consulting and
    Interim Management

    Connect with Theresa on LinkedIn

    Connect with us on LinkedIn and join our Active Network Program.

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    Develop and Maintain Effective Nurse Leaders

    According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022. In fact, the shortage is anticipated to be twice as big as when Medicare and Medicaid were introduced in 1965.

    Nursing plays a huge role in the success of our hospitals and healthcare systems today. Developing and retaining great nurses has never been more important.

    Untapped Talent

    Many organizations have "diamonds in the rough" just waiting to be discovered. The very skills that make effective nurses such as creative problem-solving skills, exceptional communication skills, and emotional intelligence are the foundational building blocks required to make exceptional leaders.

    However, being a good nurse doesn't always naturally translate into becoming good a nurse manager. Like many others who are promoted into management roles, nurses are generally not offered a great deal of assistance as they move into these new and challenging positions. Their raw talent must be inspired and carefully cultivated to become a thriving leader. With proper guidance, the transition into a senior leadership role can be very successful.

    W&A Nurse Leadership Program

    To maximize the success of our nursing clients, we have partnered with Nursing Leadership Coach Diane Scott, RN, MSN, ACC. With her strong clinical background, Diane has a deep understanding of the nurse executive role. Coaching is customized to every situation and organization, with outcomes driven models implemented to ensure success.

    Diane explains, "Senior nursing leaders usually are in charge of the majority of the workforce of any healthcare organization. They are often promoted through the ranks and experience challenges with increasing their ability to critically think at their new leadership level. However, once they reach that level, the new challenge is the overwhelming desire to meet the mission of patient care and balance a seemingly polar opposite of managing the numbers, especially financials. They also struggle with developing a self-strategy for their career, finding it too self-serving and not patient driven.
    The most successful senior nursing leaders learn that by increasing their own abilities, they can achieve their own potential, develop their managers as well as provide excellent patient care. In this way, everyone benefits under leadership that understands needs from the ground up."

    At Wiederhold & Associates, we know an organization can optimally increase a nursing leaders’ capacity for successful outcomes through professional Nursing Leadership Coaching. It is the single most powerful way for a leader to achieve their potential for superior leadership, strategic thinking, and measurable results.

    If you would like to learn more about our Nursing Leadership Program, download a tri-fold brochure here

    Connect with us on LinkedIn and join our Active Network Program.

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    Achieve Results through Physician Alignment, Integration and Engagement: Leadership and Management

    Culture of Performance Excellence: A simplified Approach

    Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”

    A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

    Vision

    As previously highlighted in Achieve Results through Physician Alignment, Integration and Engagement: Governance and Value-based Care is Here to Stay, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.

    Vision and Execution

    Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:

    • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
    • Service Excellence (service delivery exceeding patient and family expectations), and
    • Clinical Excellence (best clinical outcomes for every patient and patient population).

    More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion

    Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:

    • Governance,
    • Leadership, and
    • Management.

    Previous articles addressed physician engagement in Governance of the Physician Enterprise Organization. This article focuses on physician engagement in Leadership and Management.

    Leadership and Management:

    In addition to active engagement in governance, physician leadership and management is recommended. A dyad leadership model fosters a culture of engagement among physicians and support staff. The model includes physician leaders and operational leaders working in partnership at all levels:

    • Executive Leadership (Physician Executive Leader and Administrative Executive Leader),
    • Operational Leadership (Medical Directors and Operations Directors), and
    • Operational Management (Site Lead Physicians and Operations Managers).

    Physician leaders and managers in the dyad leadership model typically maintain an allocated time in clinical activities, in addition to allocated time in leadership/management activities. The prorated allocation of leadership/management time should be tailored to scope of responsibility and accountability.

    An Operating Team, comprised of dyad partners at the executive and operational leadership level, should meet on a routine basis (weekly or bi-weekly) as a team to share ideas and build consistency within the physician enterprise. The Operating Team maintains accountability and responsibility for translating organization-wide goals and objectives to action. The team ensures that strategy is translated into operations. Action plans and tactics are developed to achieve strategic and operational results.

    The Operating Team should meet with Site Lead Physicians and Site Supervisor/Managers on a routine basis to hard-wire operating norms. Regularly scheduled meetings of all Site Lead Physicians and Site Supervisors/Managers provide an opportunity to share best practices, build consistency and to give the practices a sense of being part of a group practice, as opposed to being isolated in individual practices.

    Executive and operational leadership team members should develop a routine of rounding at all practice locations. Building relationships with practicing physicians, other providers and support staff is essential. Day to day problem solving is best achieved through active engagement of leadership, management and staff. Those who are closest to the delivery of care typically have the most innovative ideas for how best meet the needs of patients/communities services. Routine rounding also provides the opportunity for leadership to engage with patients and families to gain a better understanding of the patient experience.

    An example organizational chart is provided below to give direction to leadership and management structure (see below). It should be noted that functional structure and infrastructure in the organization is most effective with limited layers of leadership and management, maintaining active relationships between leadership and staff. The organizational model is designed to expand horizontally, as opposed to vertically through creation of additional layers. Operational leadership should be tailored to the scope and diversity of specialty types within the group.

    Support functions are essential to success of the physician enterprise. Finance/Accounting, Revenue Cycle, Marketing/Public Relations, Information Technology, Human Resources, Facilities/Maintenance, Purchasing and other support functions may be centralized on an enterprise-wide basis or may be structured in direct support of the physician enterprise. It should be noted that functions are highly specialized in support of a physician enterprise. Whether centralized or in direct support of the physician enterprise, it is essential for operational and executive leadership to engage directly with leadership and management of the support functions to develop a common understanding of organizational needs and performance expectations. It is recommended for support functions to be actively engaged with governance sub-committees.

    Key Take Aways:

    • Active engagement of key stakeholders is essential to fostering a culture of performance excellence
    • Physicians can quickly become disenfranchised when not engaged in developing organizational vision
    • Physician engagement and satisfaction in improved when organizational vision is well executed
    • Execution is best achieved when the organization is focused on performance excellence in operations, service and clinical activities
    • Developing and Fostering a culture of performance excellence requires governance, leadership and management

    Next Steps:

    • Knowledge management and transfer through data analytics:
      • Determine the most important operational, service and clinical data analytics needed
    • Process Management through formal methodologies:
      • Determine the process management for the organization
      • Develop leadership, management and staff to focus on processes to:
        • achieve results,
        • standardize operating norms,
        • reduce variation, and
        • hardwire best practices.

      Connect with us on LinkedIn and join our Active Network Program.

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    Achieve Results through Physician Alignment, Integration and Engagement: Governance

    Culture of Performance Excellence: A simplified Approach

    Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”

    A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

    As previously highlighted, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.

    Vision and Execution

    Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:

    • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
    • Service Excellence (service delivery exceeding patient and family expectations), and
    • Clinical Excellence (best clinical outcomes for every patient and patient population).

    More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion.

    Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:

    • Governance,
    • Leadership, and
    • Management

    This article focused on physician engagement in Governance of a Physician Enterprise Organization. The article in this series will focus on establishing Leadership and Management Structure to execute the organizational vision.

    Governance:

    Hospital organizations have been inviting physicians to be members of governance structures for many years. In addition to representing medical staff activities, physicians can help foster a physician friendly culture at the board level. Gaining the physician perspective of hospital operations and embracing input will contribute to an environment of high performance. Physicians are typically viewed as customers of hospital based services.

    Governance within a physician enterprise organization (employed model or clinically integrated network) requires a very high level of engagement among physicians. Physician enterprise organizations have a profound impact on a physician’s practice and physician’s entire livelihood. A high level of governance to oversee and provide direction is needed. A physician led governing board is recommended. Physicians should be viewed as key stakeholders and leaders in care delivery.

    While physician governance is recommended, organizations may adopt a formal governing body with corporate bylaws which define scope of responsibility and accountability, or less formal governance oversight in an advisory capacity. Scope of responsibility and accountability of the physician led governance and reserved powers of higher governing authority at a system-wide level must be clearly defined. The majority of governing body membership should be comprised of physician members with predetermined representation from medical and surgical specialties from within the group. Administrative leadership is tasked with facilitating and directing physician governance through a high level of trust and credibility.

    The Governing Body of a physician enterprise organization may be structured to include the physician led board, as well as several sub-committees with defined functional oversight as defined by committee charters:

    • Policy and Procedure
    • Regulatory Compliance
    • Physician/Provider expectations:
      • Productivity
      • Access
      • Guiding principles related to citizenship and behavioural standards
      • Quality performance
      • Service performance
      • Operational/Financial performance.

    Sub-committees of the governing board are recommended to foster a broader level of engagement and participation among physician members of the group. The board may consider delegation of oversight to subcommittees to create focus and subject matter expertise through measuring, monitoring, reporting and improving performance. Sub-committees to consider include:

    • Finance Committee
      • Oversight of provider productivity
      • Oversight of financial measures
      • Capital allocation and approval
      • Oversight of Revenue Cycle

    • Clinical Quality Committee:
      • Regulatory required quality reporting
      • Non-regulatory quality improvement activities
      • Growth Committee:

    • Growth Committee
      • Provider manpower planning
      • Provider recruitment and selection
      • Provider retention
      • Provider engagement and satisfaction
      • New service development

    • Service Excellence/Patient Experience Committee:
      • Patient experience survey process
      • Patient experience expectations
      • Patient experience improvement initiatives

    • Informatics and Automation Committee:
      • System selection
      • System implementation
      • System performance and optimization

    • Physician Compensation Committee
      • Create a common understanding of fair market value for physician compensation models
      • Create incentive based compensation and align with value
      • Communicate broadly among all physician members of the group

    • Payer Relations and Contracting Committee:
      • Contract negotiation
      • Engagement in value-based initiatives

    Key Take-Aways:
    • Active engagement of key stakeholders is essential to fostering a culture of performance excellence
    • Physicians can quickly become disenfranchised when not engaged in developing organizational vision
    • Physician engagement and satisfaction in improved when organizational vision is well executed
    • Execution is best achieved when the organization is focused on performance excellence in operations, service and clinical activities
    • Developing and fostering a culture of performance excellence requires physician engagement Governance of the Physician Enterprise

    Next Steps:

    • Assess and design the Leadership and Management structure of the physician enterprise to enhance the performance excellence culture
    • Knowledge management and transfer through data analytics:
      • Determine the most important operational, service and clinical data analytics needed
    • Process Management through formal methodologies:
      • Determine the process management for the organization
      • Develop leadership, management and staff to focus on processes to:
        • achieve results,
        • standardize operating norms,
        • reduce variation, and
        • hardwire best practices.

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    Prepare Leaders for Long-Term Success

    Wiederhold & Associates currently partners with healthcare systems to support their succession planning process. One organization we are working with is unique in their foresight in planning for critical impending retirements. They recognize the need to invest on a longer-term basis to prepare their leaders for future success. Joy W. Goldman RN, MS, PCC, PDC, Executive Director of Leadership Coaching is leading the charge.

    "We not only want our clients to achieve their next career goals; we want them to excel and grow into the best leaders they can be. Now, more than ever, our world needs effective and values-driven leaders." - Joy W. Goldman

    As we work with our client systems, we know that we need to leverage confidence AND humility; individual interests AND team interests; a centralized AND decentralized focus; safety AND risk. We challenge ourselves with these polarities as we challenge our clients and client systems.

    "In working with one client, I took the risk of saying, 'It seems that you’ve been waiting for permission and approval to make a move. When are you going to take matters into your own hands and just act?' While difficult to hear, this challenge caused an empowering shift in the client. His words, after having time to process this, were: “I feel like a phoenix rising!” -Joy W. Goldman

    Our mission is to groom and develop agile leadership that is able to intelligently navigate the challenges and changes that our industry is facing. We look forward to partnering with you as you strategize your succession strategy for long-term success.

    Jim

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    Executives- Read this if you made $100k or more last year

    Last year your employer gave you a bunch of money- what did you do for it? If you cannot clearly answer this question, you are vulnerable. In today's competitive market it is imperative to create value for your employer. Employers have problems- executives are hired to solve these problems. You must be able to clearly demonstrate a ROI on your salary- otherwise you are simply unnecessary overhead. If you cannot measure improvement in profit, sales, quality, customer satisfaction, efficiency, or cost reduction from a year ago I guarantee your employer is wondering if they are getting commensurate value with the money they are giving you.

    How do you create value for your employer? First, make certain you completely understand your boss's goals- they are your goals. Second, make sure these goals are quantifiable. Third, achieve those goals. If you rinse and repeat this process year after year you will continue to create value for your employer. In turn your employer will keep giving you fistfuls of cash.

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    Value-based Care is Here to Stay

    Simplified Approach through Physician Alignment and Integration

    Value Based Care is defined as provision of services that are low cost, highly efficient, service-oriented and provide the highest quality outcomes. Consumer expectations of values in the healthcare industry will continue to increase. Serving healthcare needs of a community that meet and exceed consumer expectations is complex and multi-faceted. The healthcare industry needs a simplified approach to address complexity and move toward a coordinated care delivery system. Healthcare organizations must first define a compelling vision for coordinated care delivery. Execution of that vision is best achieved through a leadership philosophy of performance excellence.

    The schematic shown below provides a roadmap for navigating the performance excellence journey toward value-based care (see schematic). This introductory article, the first in a series, outlines a vision for maximizing organizational success in the evolving healthcare industry through physician alignment and integration. A consistent and simplified leadership philosophy is provided to assist in execution of a strategic vision. Organizational gaps that may interfere with achieving organizational vision are also identified.

    Vision and Execution:

    The journey begins with:

    • Strategic vision for the future, and
    • Execution of the strategic vision through a leadership philosophy and organization culture of performance excellence.

    The culture of performance excellence focuses on measurable results and outcomes in three main areas:

    • Operating/Financial Excellence,
    • Service Excellence, and
    • Clinical Excellence.

    Performance excellence is best achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Organizational Gaps:

    Physicians and other providers are often not fully aligned with hospital organizations. Competing interests among physicians, other providers and hospital organizations may exacerbate misalignment. Hospital organizations know they need physician alignment and integration strategies. Many hospital organizations are unclear regarding scope of physician alignment and integration strategies. Some hospital organizations tend to view integration as a model of employment only, when there is a vast array of physician integration models.

    Each hospital organization possesses a unique climate and organizational culture for effective physician integration. Execution of physician integration strategies may lack depth of understanding. Structure and infrastructure needs for effective strategy execution are often underestimated. Governance, Leadership and Management representation among physicians and other providers is necessary, but often ignored. Significant variation in level of engagement exists among key stakeholders in healthcare delivery. High levels of engagement in organizational change are needed among leadership, management, physicians, other providers and staff, as key stakeholders in the delivery of care. Common understanding among key stakeholders is often lacking.

    Traditional healthcare leaders may have a tendency to exert “control” rather than engage physicians and other providers when focusing on organizational initiatives to improve care delivery. In addition, development of multi-disciplinary teams to focus on organizational initiatives may be difficult. Multi-disciplinary teams are especially prone to experiencing team dynamics of forming, storming, norming and performing. Many organizations have a low tolerance for the highly productive storming phase of team development, especially when physicians are involved. Embracing physician input is imperative.

    Many healthcare organizations have not adopted a meaningful and comprehensive process management methodology. There may be tendency to focus process management efforts within the confines of the hospital organization. Process management initiatives must become much broader in scope, must address care delivery across the entire continuum of care, and must focus on enterprise-wide initiatives, including care delivery in physician offices. Application of a formal and reliable process management methodology is often underestimated. Establishing an enterprise-wide process management approach requires vision, and investment of time and money. Physician stakeholders, being scientifically trained, tend to naturally adopt process management principles. The investment in education and training may be substantial. A multitude of models exist and it may be difficult to select and sustain a consistent approach that is embraced by all key stakeholders.

    There exists an ever-increasing emphasis on service, cost and quality outcomes. Government payers are increasing regulatory requirements, but those requirements may not be universally understood. Variation in understanding among key stakeholders may exist. Non-governmental payers may institute additional requirements and variation adds complexity and lack of common understanding. Employer demand for reduced healthcare costs, while providing service oriented and quality services, creates another set of demands on healthcare providers. Suppliers and vendors to the healthcare industry lack a comprehensive view of what is needed to improve service delivery.

    Traditional hospital based healthcare organizations are deeply grounded in meeting the needs of the communities in which they serve. Traditionally, hospital based organizations have long and established histories of serving patients at times when they are most in need of life saving intervention. Consumers and payers of the healthcare industry expect an effort to create healthier communities and to reduce high cost, episodic and acute interventions. Healthcare systems are not always well positioned to meet comprehensive consumer expectations beyond episodes of care. Healthcare systems have traditionally survived and measured success, based on payment models that encourage utilization of high cost, revenue producing services. The path to managing the health status of communities at lower cost requires engagement and alignment of services outside of the acute care setting.

    Key Take-Aways:

    The future of the healthcare industry is uncertain. Care delivery is complex and multi-faceted with organizational gaps impeding the journey to designing and developing healthcare systems to meet ever increasing consumer expectations of value. The healthcare industry will continue to experience constant pressure to modify and change current care delivery systems to meet rising consumer expectations. Navigating the journey to coordinated care delivery across the full continuum of care requires strong vision for the future and a refined leadership philosophy.

    This article provides a simplified approach to defining a compelling organizational vision. The need for a leadership style and organizational culture of performance excellence are outlined. Gaps in traditional organizational approach are also highlighted. The schematic below provides a roadmap for comprehensive improvement.

    Future articles will provide additional detail related to how to lead the performance excellence journey to achieve an organizational vision of the future.

    Next Step: Evaluate the company’s governance, leadership and management structure to identify opportunities for meaningful formal and informal engagement.

    Performance Excellence Roadmap toward Value Based Care

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