By Steve Berkowitz

Many of us are now looking forward to next year’s budget, strategic plan, and either updating or enhancing the quality dashboard.  Additionally, this time of year, there may be new Board members and medical staff officers, some of whom may need to be educated on the above processes, in particular, the quality improvement initiatives. 

At a minimum, one needs to better understand the quality dashboard, the indicators which comprise that dashboard, and the process by which the system will improve performance.
It is easy to get overwhelmed with quality indicators. Many health care systems track hundreds of them on a regular basis. Ultimately, these indicators should roll up into a single dashboard. 

When educating new Board members, it is tempting to have them “drink from the firehose” by showing them all of the indicators that the system is tracking, and it is not hard to quickly lose the audience in a sea of data and acronyms. Oftentimes, and sometimes out of shear frustration, a prudent Board member will ask the question: “How did you determine which of these indicators to incorporate into the dashboard?”

So, both the time of year and the need to educate new leadership makes now a good time to revisit the concept of “Indicators for Indicators”...Specifically, out of the myriad of indicators that are tracked, how do we pick out the cherished few that will be reported to the Board and management on a regular basis?

Having worked with many systems over the years, the following points have greatly assisted me in transforming this mass (or morass) of data into a useable, effective dashboard that will drive the appropriate results necessary to move the organization forward.

1.  The dashboard should be just one page (and not done so with micro-print!) It should go without saying that the document is concise, easy to read, and will enable the readers to quickly focus onto the most important indicator at the time. Often, the indicators are color-coded red, yellow and green, so that the outlying indicators are quickly apparent.

2. The dashboard should consist of 3-6 Value categories, as outlined by the organizations mission, vision and values. Examples would include: patient safety, quality outcomes, cost-effectiveness, citizenship, mission goals, etc.

3.  The total number of indicators to populate the system dashboard should be distilled down to approximately 8-12 individual data entries.

4.  All the indicators for the individual members or departments of the system should roll up into a common dashboard. Having said that, I do acknowledge that there may be specific issues within an individual entity that must be managed, and that they may deserve a place on the local dashboard.  But ultimately, everything that is monitored and managed should roll up to the ultimate success of the organization, and correlate with the entries of the system dashboard.

5.  The dashboard is a dynamic document that needs to be continually managed and massaged as the organization and the health care climate changes.  Individual indicators will change with time, either because the appropriate result has been obtained, and the indicator is no longer needed, or a more important indicator has arisen to take its place.  Incidentally, the Value categories should not change much through time

6.  The ideal indicator should have the following attributes:

a.  The indicator must be significant to the organization. Put simply, if the organization is going through the effort to obtain and manage this indicator, the successful accomplishment of that indicator must have a significant positive effect on the system.  Otherwise, it is a waste of time.  The fundamental premise is that the successful accomplishment of the components of the dashboard will result in the success of the system.  If this argument cannot be made, it is not worthwhile to include that data as part of the dashboard.

b.  The indicator must be measurable.  The organization must have the capacity to appropriately abstract and obtain the indicator. Typically, many of the indicators are obtained through the existing EMRs.

c.  The indicator must be reasonably objective. There should be a common, agreed-upon, definition for that indicator. Any ambiguity should be minimized, if not eliminated. There should be no ability to “game” that number to benefit the organization.

d.  The indicator target must be obtainable with reasonable effort. It does no good to track an indicator that cannot be accomplished. The targets should be aggressive but doable by the organization.

I have found the above thoughts to be very useful, both in the day to day operations of the system, and as part of the ongoing leadership educational program.

Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success!

By Steve Berkowitz

The scene is all too familiar: a physician in the Medical Group suddenly leaves or develops an extended illness.  An atmosphere of panic pervades the clinic. Who will see that physician’s patients?  How quickly can we get another physician? Where do we recruit? What do we do in the mean time?

All Medical Groups face these situations on a regular basis. Having consulted with many Medical Groups across the country over the years around the issue of recruitment and retention, here are some tips that should be considered by your Group:

1. Develop and Implement a Recruitment Plan for the Medical Group. Ideally, this plan should be in place BEFORE the event. Several factors must be considered in the successful development of this plan.  Importantly, it must tie to the overall needs of the Group and must be an integral component of Group’s Strategic Plan.

There are several key issues to consider: The Group must first determine which services/specialties are needed within the Group as well as the costs/benefits of providing such services. Then it must be determined if there is a specific need within those services. Multiple issues to consider include the desired/ ideal panel sizes for primary care, productivity assessments for all current physicians, geographical or office coverage issues, and the potential for growth, to name a few. These factors determine the ideal number of physicians for each specialty in a given geography and the Group can objectively determine if there is a gap and whether recruitment is even necessary.

The recruitment plan, like the Strategic Plan, should be periodically reviewed and adjusted as the needs of the Group change.

2. Develop a Medical Group Charter. This document defines the ideal physician for the group in terms of the Group’s mission, vision, and values as well as acknowledging the cultural issues, both overt and covert, that exist within the Group. The cultural piece needs to be discussed openly and frankly amongst the providers. For example, does the Group expect high productivity/ high compensation amongst its physicians, or does the Group “set the thermostat” at a lower workload/ lower pay expectation? These cultural expectations are critical to discuss especially as one considers the compatibility of future recruits.

The Charter becomes an integral part of not only the recruitment process, but also a part of the compensation/ incentive program for the Medical Group, as those physicians who most embody the spirit of the Charter should be those most rewarded in the compensation plan.

3. Just because a physician leaves the Group does not mean an additional physician should be recruited. A recruitment plan is not a glorified replacement plan. Despite the chaos that can ensue with a sudden physician vacancy, as described above, there is now an opportunity for the Group to reevaluate the need for recruitment. Do not get cajoled into thinking that just because a physician has left, there is an automatic need to recruit another.  There may be other options for the Group to consider, such as redistributing patients to other, less busy physicians.

4. Utilize a standardized process for recruitment. As new physicians are added, the Group needs to develop a consistent methodology to most insure hiring the best physician. It is imperative that the recruited physician have a reasonable understanding of what will be expected by the Group. Compatibility with the Group Charter is essential.  Group expectations in productivity, on-call and work/life balance must be clearly articulated.

It is important that as many members of the Group as possible personally evaluate the applicant. Likewise, the applicant should have the opportunity to interview as many of the physicians in the Group as possible. Both parties must honestly assess the situation and make the best decision objectively. It is OK for either party to disagree and walk away.

The worst-case scenario is not the absence of the physician, but rather the “miss-hiring” of the wrong physician.  The inappropriate hire can be considerably costly to the group in many ways down the road.

5. Develop a strategy for physician retention. Turnover has a considerable cost in terms of lost patient visits, lost time in diagnosis/treatment of patients, increased workload for the remaining physicians, and the time-consuming and expensive process of finding a physician and acclimating that physician to the Group.  By and large, turnover should be minimized.

However, one must acknowledge that some turnover is good—not only if there is a quality or competency issue, but also if that physician does not fit in with the culture of the Group, or is not compatible with the values of the Medical Group Charter.

But the huge cost of turnover should be recognized by the Medical Group. Physician retention is the best way to minimize the need for recruitment.   What is being done by the Medical Group to encourage the good physician to stay?  Ideally, recruitment should be reserved for Medical Group growth.

Many groups routinely assess the satisfaction of the physicians, and adapt accordingly.  Your Group should strive to be the ideal place to practice medicine in the community.  Are you creating an environment where the good physician wants to stay?  Are symptoms of burnout promptly recognized and addressed?  Are there long-term benefits and incentives in the compensation program?

6. Leaving is the final step in the process of being dissatisfied.  What are you doing to recognize physician dissatisfaction early on, and what are you doing about it?  Many times, appropriate intervention can obviate the need for the physician to leave.  There is a great opportunity here for "preventive medicine."

Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success!