July Management Retreat

Last Tuesday the leadership of Asante gathered at our Smullin Center to spend the day focussing on another one of our strategic goals for the organization.  This day's topic was regarding our relationship with the medical staff.  I found it very informative even though the information was both disconcerting and very complex.  I'll try to summarize the 8+ hours of meetings into a few paragraphs here.

The underlying story is that healthcare is entering into an era of unprecedented change.  Reimbursement can no longer be as it has been, and as we move into a period of value-based purchasing our need to respond will determine our ability to survive.  It is clear that "value"  (outcomes, satisfaction, cost, health of the population) is driven at least as much by physicians as by hospital staff.  Without physicians who align their behavior with the goals of the organization, we simply cannot be successful.  And, for physicians who choose the path of autonomous practice, the future for outlyers looks very risky indeed.

So the path of Asante is to better align our physicians' interests with the goals of the organization.  This alignment has many forms, but includes increased employment of physicians by the hospital.  Those innovative arrangements are yet to be completely evolved, but it is clear that in the next few years the tone and tenor of physician relationships will change radically in the Rogue Valley. 

In perhaps the most radical departure from the past, we will not work with physicians whose goals are at odds with those of Asante, or whose behavior and customer satisfaction detracts from our overall results, or who display a "my way or the highway" attitude.  We will see some physicians hit the highway.

This will be disruptive.  Since it's largely new territory, we'll have some false starts to our initiatives.  Common interests will create strange bedfellows, and former best friends may depart.  Interesting times.

Part of the day consisted of six physicians (three from each hospital) sitting on a panel for one hour, and discussing on stage what it's like to practice in our system.  It gave us a flavor for their challenges and needs.  Here's the bullet points that I took away from that discussion:

• They need information.  Quickly, easily, and seamlessly.  They need efficient work processes that allow them to be as productive as possible.
• They need to trust the hospital leadership.  And they need to hear about follow through on concerns.
• Physicians are focussed on the patient experience.  When the patient is seen on followup, they want to hear that the experience was positive.  And they all agreed that it takes very little to turn the experience into a negative one.  It can be as small as a bandage left on the floor of the room, or (more commonly) delays in answering call lights.
• Physicians, especially surgeons, do not want us to un-do what they have done for the patient.  Safety, teamwork and attention to detail are critical to success.

There was also a delightful exchange between a cardiologist, an OB-GYN and a colorectal surgeon about the most important organ of the body.  The cardiologist, of course, said it was the heart.  The OB stated with certainty that it was the vagina.  The surgeon had the last word, insisting that the rectum was the center of the body!

Next was a discussion of our pending implementation of the EPIC electronic medical record.  That work is getting underway now, and based on experiences at EPICs other sites it will solve many of the communication, efficiency and safety concerns of physicians and the hospital.  This will be one of our very highest priorities until go-live in spring of 2012.

The next few years will not be for the faint of heart.  This will be a time of uncertainty, very hard work, and stress.  It is also the time that we all have the opportunity to set the bar for the best 21st century healthcare system in our region.  I'm convinced that it will be Asante.