Transcript Thoughts from Christiana Care— an Academic Community

Medical Staff Leadership as an Agent
of Safety & Quality in Healthcare
Organizations:
Relationships & Teamwork
Keith Doram, MD, MBA, FACP
Sr. VP and Chief Medical Officer
Christiana Care Health System
Associate Professor of Medicine
Penn State College of Medicine
Harry Truman once said…
“You know what makes leadership? It is the
ability to get men to do what they don’t want
to and like it.”
Learning Objectives
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Better understand how medical staff
leadership can influence the ability of a
healthcare organization to improve patient
safety & quality
Discuss barriers for medical staff and
healthcare administrators related to
leadership and good relationships
Provide an overview of the Christiana Care
Heath System and the role of the Chief
Medical Officer
Useful Definitions
Leaders are people who do the right thing; managers
are people who do things right. Both roles are
crucial, but they differ profoundly. I often observe
people in top positions doing the wrong thing well.
- Warren Bennis
Safety is first & foremost “doing no harm”.
Quality (in hospitals & healthcare) is doing the right
thing right—not just for one patient, but for all
patients.
Twelve Leadership Competencies
(The M.I.C.P.S. – Management Incentive Comp Plans)
Managing Relationships
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Cultivating Relationships
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Conflict Prevention and
Negotiation
Influencing
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Building Coalitions
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Advocacy
Communication
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Responsiveness
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Information Brokerage
Performance & Quality
 Set Goals & Standards
 Accountability
 Manage Change
Setting Direction
 Vision & Purpose
 Org. Perspective
 Initiative
Source: Advisory Board Interviews
and Analysis, 2004
Effective Executive Leadership,
according to Peter Drucker:
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There appears to be little correlation between
a person’s effectiveness and his/her
intelligence, imagination, or knowledge.
Brilliant men/women are often strikingly
ineffectual; they fell to realize that brilliant
insight is not by itself an achievement.
The good news is that, “Effectiveness can be
learned”.
Effective leader executives can be fat or lean,
extrovert or shy, drink a lot or not at all—but
they all share five habits or practices…(Drucker)
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Know where there time goes and manage it
Gear efforts to results than to work
Build on strengths not weaknesses
Concentrate on a few things that will
produce outstanding results
They make effective decisions
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Judgment based on “dissenting opinions” rather
than on a “consensus of the facts”
Most Hospitals are in need of a New
Leadership Model
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“ I thought about becoming a leader in my
speciality, but it didn’t seem that compelling.
I’m really interested in bringing in new
technologies and growing our service…but
leadership in this hospital is all about going
to meetings and making sure new doctors fill
out their paperwork.”
–
Anesthesiologist, Large East Coast AMC
Organizational Barriers for Physician
Leadership in Hospitals
(Source: Physician Leadership Academy, 2004)
Administrators’ View
1. Undervalued Prtnrshp
2. Insuff. Follow-thru
3. Insuff. Analysis
4. Lack of knowledge
5. Inadequate Structure
6. Poor negotiations
7. Insuff. role definition
Physicians’ View
1. Lack of knowledge
2. Poor peer relations
3. Insuff. Analysis
4. Undervalued Prtnrshp
5. Insuff. Follow-thru
6. Inadequate Structure
7. Lack of commitment
Comments from physicians:
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“Talking to administration is like talking to the
boogeyman.” – Southeast physician leader
“Physicians aren’t very collaborative people.
And they resist change probably more than
the average person. And while they agree on
conceptual issues, they have great difficulty
in actually working together to achieve their
goal.” – Physician leader, Advisory Board Focus Group
Key Factors That Determine Physician
Leadership Involvement in Hospitals
(Source: Advisory Board 2002 Survey of 531 physicians in 10 specialties)
1.
2.
3.
4.
5.
Compensation for time spent working on
hospital issues
Provision of support staff by hospital
Personal interest
Opportunity for research and publishing
Opportunity for prestige and recognition
CCHS has a mentorship program, a formalized yearround faculty development curriculum with the ACP
Executive training program and the Advisory Board
Key Factors That Motivate and
Determine Physician Behavior
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Good Rationale
Peer-Pressure
Real Threats
Money
JCAHO safety/quality measures are a
great yardstick for EBM – Do you think
the doctors share that view?
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JCAHO Pt Safety Goals are EBM
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Improve accuracy of patient ID
Improve effectiveness of communication among
caregivers (e.g., readback, abbreviations)
Improve safety of using medications
Eliminate wrong-site, wrong patient…surgery
Improve safety of using infusion pumps
Improve effectiveness of clinical alarm systems
Reduce the risk of healthcare-acquired infections
JCAHO and Quality – has 18 standing
advisory groups and a number of
coalitions (AMA, ACC, AHA, AHRQ,
CMS, NCQ, Pharmacopoeia…)
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Benefits of Beta-Blockers for Acute MI
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Clinical Trials: STEMI, MIAMI, ISIS-1, TIMI-II
15% Lower mortality over 7 days (p = 0.05)
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Circulation 2004;110(5):588-636
Lancet 1986;2(8498):57-66
N Engl J Med 1989;320(10):618-27
Am J Cardiol 1985;56(14):10G-40G
These Standards are Just Good EBM!!
Learnings from CCHS…
Key Metrics
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7,000
60,000
51,000
1,000
1,200,000
135,000
Births (Level IV Neonatal Care Unit)
Admissions
Surgical Procedures
Open Heart Surgeries
Outpatient & Home Health Visits
Emergency Department Visits
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Level 1 Trauma Center
1,200
Medical/Dental Staff
$1.2 Billion Annual Health System Revenues
Education
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220 residents & fellows
Diagnostic Radiology
Emergency Medicine
Emergency Medicine/
Internal Medicine
Family Practice
(Osteopathic and Allopathic)
General Practice Dentistry
General Surgery
Internal Medicine
Medicine/Pediatrics
Obstetrics and Gynecology
Oral and Maxillofacial Surgery
Osteopathic Traditional
Rotating Internship
Preliminary Medicine Year
Pharmacy Practice
Podiatric Medicine and
Podiatric Surgery
Transitional Year
Neonatology Fellowship
Education
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420 medical students
Delaware Institute for Medical Education and Research,
(DIMER)
Delaware Institute for Dental Education and Research,
(DIDER)
Affiliation
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Jefferson Medical College
University of Delaware
Delaware Technical and Community College
Research
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3
55
26
3
18
40
7
2
84
2
9
10
41
19
2
Bone Marrow Transplant
Cardiology
Critical Care/Trauma/Surgery
Adolescent Medicine
Diabetes
Emergency Medicine
Family Medicine
Genetics
GYN Oncology
HIV
Infectious Disease
Internal Medicine
Maternal Fetal Medicine
Neonatology
Neurology/Neurosurgery
4
11
2
205
2
21
15
2
96
3
1
7
5
5
32
Nursing
Obstetrics/Gynecology
Occupational Health
Oncology/Hematology
Orthopedics
Other Research
Pathology and Laboratory
Pediatric Neurology
Pediatric Oncology
Pediatrics
Perinatology
Pharmacy/Pharmacology
Preventive Medicine
Pulmonary/Respiratory
Radiology/Radiation Oncology
732 Total Clinical Trials