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Engaging the C suite: practical communication strategies to achieve hospitalist goals Mark Novotny, MD, SFHM Lakshmi Halasyamani, MD, SFHM Why shoul...
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Engaging the C suite: practical communication strategies to achieve hospitalist goals

Mark Novotny, MD, SFHM Lakshmi Halasyamani, MD, SFHM

Why should you listen to this talk? • Instead of : – here is how we will bore you, then we’ll bore you, then we will tell you how we bored you….

• What have we done that could inform your work? • And, we will ask you : what are your greatest challenges?

Our stories…… • Mark

• Lakshmi


Session Overview – What we are planning to cover • • • • •

Introduction C-suite membership and goals Hospital Medicine and the C-suite Developing a common language: Business plan Table top session to practice using driver diagrams and business planning tools • Wrap-up

So how can we customize to your needs?

• What are your greatest challenges in getting the attention of the C suite?

Who is in a C-suite? • • • • •

Chief Executive Officer Chief Operating Officer Chief Financial Officer Chief Medical Officer Chief Nursing Officer


Why is this even a problem? • The healthcare environment makes it hard to get anyone’s attention – Information overload, competing priorities

• The C suite is moving from technical to adaptive leadership – Technical answers are not enough when the future requires all of us to shed ‘ways we have always done things’ while preserving what is precious, and adapting to an unknown future

• The C suite members typically think differently from front line clinicians

Victor Frankel • “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way." • It makes a difference– personally • [I am the one who makes choices here]

– and as a leader • It’s all about us and the choices we make; we can’t point to the environment

• Man’s Search for Meaning in Life

Here’s how most think about the hierarchy of health care: Regulators Hospital Board


Middle Management Financial resources/ Budgets Clinical Service Lines

Nursing Pharmacy/ IT / Human Resources ICU/ ED/ Med – Surg/ Post op Hospitalists &

the Patient


Isn’t it really more like this?

ICU/ ED/ Med – Surg/ Post op Hospital Board


Patient & Hospitalist


Pharmacy/ IT / Human Resources

Middle Management


Clinical Service Lines


Financial resources/ Budgets

Superstars vs Teams?

• 1980 Olympic Team

• 2004 Olympic Team

– Rookie team. – Highly motivated, passionate. – Worked as a team to win a gold medal.

– Talented athletes. – Didn’t work as a team on the court. – “Superstars” do not make a team.

Physician Leadership New Skills & New Knowledge for a New Role

PHYSICIANS Doers 1:1 Interactions Reactive Personalities Prefer Immediate Gratification Decides Value Autonomy Independent Patient Advocate Identify with Profession Deductive

MANAGERS / LEADERS Planners, Designers 1:n Interactions Proactive Personalities Accept Delayed Gratification Delegates Value Collaboration Participative; Inter-Dependent Organization Advocate Identify with Organization Inductive


Open Communication vs. The “Iceberg of Ignorance” What % of the Organization’s Problems Are Known to... 4%

Top managers


Middle managers



Problems unknown to management

100% Front-line employees Adapted from Sydney Yoshida-Japanese Quality Expert

Making the Connection

• What’s important to your audience? • What will get and hold their undivided attention? • The answer is the same for CEO, CFO, any leader, any doctor, any person – It is the speaker’s job to demonstrate (quickly) that what you want them to buy, support, agree to, etc.

Is in their best interest after Charles Dwyer, “Shifting Sources of Power and Influence”

So what is in the C suite’s best interest? • Find out before you get there… • They have actually written it down: – Read the strategic plan and this year’s operating plan – What are the goals of the organization? – How is what you want to do aligned with those goals?

• Messages you might consider will be heard: – We can improve care and reduce cost – Our goals achieve system goals- here is how – We are willing to manage money and people and be accountable for outcomes


Also need to know “who” to talk with… • There is the formal org chart, and then there is the ‘real’ set of relationships that matter. • Figuring out who are the ‘nodes’ of social influence and how that affects the transfer of information is also important- who do I need to talk with before the meeting • Who does the CMO, CNO, CFO, CEO listen to? • How do the members of the C suite relate to each other? Both formally and informally….

The social life of information

Selling to the C suite


Evidence based research on the C suite from “Selling to the C suite” • The relevant executive is the one who most feels the pain, most owns the problem you can solve, and will most richly reward you for providing a solution. The relevant executive will be someone with a combination of rank and political influence, with an internal network that allows her to initiate projects, kill projects, intervene in projects, and find funding, both in her own silo and across departmental boundaries. • The relevant executive is not always found at the C level.

A System for Execution of Breakthrough Goals- IHI TomNolan…http://www.ihi.org/knowledge/Pages/IHIWhitePapers/Execution ofStrategicImprovementInitiativesWhitePaper.aspx

1. Set corporate breakthrough goals connected to organizational measures 2. Develop a rational portfolio of projects to support the goals 3. Deploy resources to the projects 4. Execute each of the individual projects in the portfolio 5. Oversee and learn from the measures

Strategic Alignment and Learning- courtesy of IHI

System wide goals



(Core Theory of Strategy)

(Ops Plan) What are your Down deep, what What set of key strategic really has to be projects will aims? What are changed, or put move the Drivers the system-level in place, in order far enough, fast measures of to achieve each enough, to those aims? How of these goals? achieve your good must they aims? be, by when?


Strategic Alignment and Learning

System Goals


Projects (Ops Plan)

•Operating Margin (4% 2008) •Patient Satisfaction (90th percentile 2008) •Mortality Rate reduction to 0.65 (35% better than median)

Strategic Alignment and Learning-IHI

System Goals •Operating Margin (4% 2007 •Patient Satisfaction (Top Box 75% 2008)

•Mortality Rate reduction


Projects (Ops Plan)

•Reduce harm index (IHI trigger tool) from 18% to 10% •Reduce hospital admissions for end of life symptom management by 50%

Strategic Alignment and Learning

System Drivers Projects Goals •Operating Margin (4% 2007 •Patient Satisfaction to exceed 90th percentile

•Mortality Rate reduction 35%

•Reduce harm index (IHI trigger tool) from 18% to 10% •Reduce hospital admissions for end of life symptom management by 50%

•Reduce incidence of hospital acquired infections

Tasks •reduce aspiration and postop pneumonia rate per 1000 patients by 15% •Improve compliance rates with CDC hand hygiene guidelines from 74% to 95%


Cascading the strategy: example CEO


Unit Manager; Nurses

Decrease mortality 35%

Achieve 100% Front line input on Unit coordinator reliable process of order sets on cmte pneumonia Enforce interventions mandatory orders

Drivers: • MD/RN

Drivers: •Order sets •Information at time of service


• •

Infections End of Life

IT and Quality Dept. Execution of order set improvements

Resources to on line order sets MEC-Design and Execution of policy on admissions

Ssome examples from Mark’s organization MEASURE


Potential SECONDARY DRIVERS Work Redesign/Productivity Premier system Waste Identification Tool Overutilization of Testing Casemix & documentation improvements Standardized Order Sets No salary increases

Productivity Improvement/ Waste Reduction

Reduce cost while at the same time improving or maintaining quality. Achieve $5 million contribution to plant, property and equipment

Denial management Hospitalists – flex staffing, learn self model adult & pedi

Six mesosystems teams – NEED NAMES

Increase Contributions/ Fund Raising ARRA Funding Reduce Cost of Borrowing Reduce Capital Expenditures

Maximize Reimbursement from Payers

Community outreach Achievement of Meaningful Use at CDH and CDPA Bond Rating Interest Rates Identify right level for Capital Budget. Identify what we should buy. Sell equipment

Legislative mandates – political environment, lobbying. Maximize payer contracting – pay for performance, cost of care, utilization, physician participation, ACO contracting

Charge Capture – eliminate missed charges, compliance

Maximize pmt through improve MD and coder documentation compliance - training


Elements of a business plan • • • • • • • • • • • • • •

Executive Summary Project Description Strategic Rationale Mission Discernment and Community Benefit (if part of a non-profit and/or faith-based organization) Industry and Technology Trends Market and Competitive Analysis Legal and Regulatory Analysis Operational/HR/Clinical Operations Improvement Considerations Construction Project Requirements Risks, Alternatives and Contingencies Financial Performance Implementation Plan Performance Measures Appendices

Example • Project Description – • A three hospital health system had two hospital medicine services that competed with each other for volume. The separate services resulted in confusion on who was covering and inconsistency in communication within the healthcare team. Leadership of both services recommended integrating the services into a single Hospital Medicine Program.


Strategic Rationale • Integrating the programs into a single program was strategically aligned with the three core organizational strategies of – Physician alignment – Patient first – Growth

Risks, Alternatives and Contingencies: SWOT Analysis • Strengths – – – –

Potential for improved team communication Single leadership structure Reduced expenditures over time Clarity of accountability

SWOT Analysis • Weaknesses – Less choice in referral options for primary care physicians who refer to hospitalists – Workforce turnover – Short-term workforce challenges


SWOT Analysis • Opportunities – Ability to recruit physicians specifically to the goals of the integrated program – Improved patient care outcomes – Improved team communication and improved employee engagement – Reduced nursing turnover

SWOT Analysis • Threats – Inability to recruit high quality physicians and clinicians – Competing priorities – Poor local economy

Financial performance • Development of key financial metrics • Revenue (patient encounters and pay for performance) • Expense avoidance (LOS and Readmission improvement) • Expenses (Physician and clinician salaries and benefits; leadership for program) • Consolidation of support to a single program with a goal of decreased support per physician FTE over time


Implementation Plan • Development of Leadership team with C-suite champion and owner • Development of Contract and Physician compact • Move to a full geographic-based clinical model • Physician and PA and NP recruitment • Routine organizational communication

Performance Measures • Capacity management – LOS – Discharges by 11 am – 30-day readmission rate

• • • •

Patient care outcomes Patient satisfaction Referring physician and team satisfaction Financial performance

Exercise: create a driver diagram that links your work with system goals, and a business plan to support your project • Use a blank piece of paper and sketch the boxes • Or use the simple table templates provided • Think through what the most powerful drivers of your organization’s system goals are- and how your program can leverage those drivers – go from goal to drivers to projects- resist the temptation to ‘make a fit’ for your existing pet project ! • Make a list on influencers you need to talk with – the relevant executives and organizational/physician leaders • Sketch out the business plan • Report out


A little more about the business plan… • Materials on tables – Full business plan template – Abbreviated version

• • • •

We will use abbreviated version today Items in italics are required elements so focus on those Use the driver diagram you just completed to assist you Mark and I will be walking around to support you in this work

When you go home…… • What proposal will you choose that aligns with organizational goals • Who will you meet with? • Take a draft driver diagram and business plan • Get approval and improve care in your shop!