Healthcare Value 

John Byrnes

The environment of healthcare reform and the drive for quality and cost containment have created a critical need for physician champions who can deliver on the value proposition.

We need physicians who can lead their colleagues to improve clinical outcomes, safety, and the patient and family experience-all while reducing the cost of care.

As an example, in our organization, Spectrum Health System, physician champions lead quality improvement teams that reduce complications, mortality, and readmission rates to improve clinical outcomes. The savings opportunities from reducing complications alone could be quite substantial. In one of our hospitals, for example, we could save about $3 million annually by reducing complications in percutaneous coronary interventions, and roughly $1.5 million annually by reducing complications from intestinal resections. Physician champions help capture these savings by ensuring that all clinical staff use evidence-based protocols and order sets for the high-volume, high-cost, and high-risk medical conditions and surgical procedures performed in their departments.

Revenue gains from pay-for-performance and value-based purchasing programs yield further benefits, largely as a result of physician leadership. For our flagship hospital, these programs generate revenue in excess of $20 million annually.

Physician-led quality improvement teams also maximize performance in the areas reported by the Centers for Medicare & Medicaid Services, The Joint Commission, the Agency for Healthcare Research and Quality, HealthGrades, Thomson Reuters, and The Leapfrog Group. Together, these organizations provide patients with access to information on core measures, complications (including healthcare-acquired conditions), mortality, readmissions, patient safety, the patient experience, and procedure volumes and safety practices.

The value of these ratings has risen significantly. The Thomson Reuters 2010 PULSETM Healthcare Survey notes:

Most Americans say they would look for a hospital rating.... [I]f their hospital receives a bad rating, nearly 75 percent say they would change hospitals.... If specialty care is needed, slightly more than half would seek out the best-rated facility rather than go to their community hospital. If a serious illness is involved, nearly 60 percent would rely on ratings rather than community location in seeking care.

The implications for market share and community perception are substantial.

Qualities of a Champion

Who makes an ideal physician champion? Not all first-time physician champions are successful, and there's an all-too-great likelihood that they will fail. It's therefore important to carefully consider who has the traits, experience, and expertise that will tip the scales in his or her favor-and who will be a good match for the organization and the culture of his or her individual department. Ideal candidates demonstrate mastery of the "soft skills": Emotional smarts, a diplomatic demeanor, integrity, the respect of their peers, and insight into the culture of their departments and organization are just a few of the intangibles that make a good physician champion.

Simply speaking, you are looking for an atypical physician. No disrespect intended to my colleagues, but the skills needed for this role were not taught in medical school or residency. More often than not, we (physicians) have developed traits and learned skills that are the antithesis of good leadership and teamwork. We're independent-minded, autonomous, and used to making unilateral decisions. We like to be the captain of the ship.

A good physician champion is one who has "unlearned" these behaviors-or who has never learned them in the first place, despite the influences of traditional physician training. A physician who can lead his or her peers is also one who embodies the qualities of an ideal manager. He or she is less likely to be the officially appointed department chair and more likely to be the unofficial leader or influencer in his or her department.

Our health system's most successful physician leaders in many ways exemplify the requisite traits: They are self-starters who are extremely well-respected by their peers, diplomatic and well-spoken, motivated, and passionate about their work-and they have that twinkle in their eye. They often are described as being "people persons" and charismatic. They are comfortable speaking in front of groups, being assertive but not authoritarian. They are good listeners and great team players. They enjoy working with their peers-and can be effective across all specialties.

Ideal champions have a reputation not just for leading their peers, but also for being able to persuade them to do the unlikely. This is truly an intangible skill set. They're not sales people; rather, they have a way about them that enables them to lead other physicians and convince them to change their practice patterns and standardize their clinical protocols. These are challenging tasks by most standards, but these physicians just seem to have a knack for accomplishing them while maintaining and fostering mutual respect. In short, you're looking for the ones who speak the "language of physicians" and have the magic touch to get Dr. Difficult to follow along. How do you identify these leaders? Talking with your physicians is a good place to start.

What to Expect from a Champion

Once you've found your champion, what can you expect as he or she drives value through your organization? I have just seen what can happen in my own organization. As I write this column, we are kicking off a high-reliability safety project in Women's Services. I have just witnessed one of our most successful and inspirational physician leaders give an impassioned presentation, and looking around the room, I could see the lights coming on in the eyes of audience members. I knew by the time he was done, we would have enthusiastic physicians and nurses ready to make significant changes in how they approach their work, ready to begin converting their departments into "high-reliability units," and ready to drive error rates continuously to zero and drive safe, cost-effective care-that is, value-throughout their departments.

This physician leader has championed some incredible results at our system's children's hospital. At the time of this writing, the serious safety event rate (errors resulting in harm) has dropped to an all-time low, and 210 days have passed since the last event, the longest interval in four years. There have been no catheter-associated blood stream infections in 10 months, only one case of ventilator-associated pneumonia in the pediatric critical care unit in the past 27 months, and only one in the neonatal intensive care unit in past 17 months. And not one medication error has led to patient harm since 2008. Most strikingly, we have developed a pediatric early warning system that has decreased codes outside the ICU by 62 percent. All of these improvements have boosted patient and staff satisfaction and contributed millions in cost savings to our bottom line. The physician champion has been instrumental in making each one possible.

In short, results like these will tell you whether you've found your ideal physician champion-one who can drive value, better quality, and improved safety at lower costs.

John Byrnes, MD, is senior vice president and chief quality officer, Spectrum Health System, Grand Rapids, Mich.; clinical associate professor, MSU College of Human Medicine, Grand Rapids; and a member of HFMA's Western Michigan Chapter.  

Publication Date: Wednesday, February 01, 2012

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