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How to Engage & Align Physicians
To Drive Improvement
Jay Kaplan, MD, FACEP
Practicing Clinician and Director,
Service/Operational Excellence, CEP America
Medical Director, Studer Group
Board of Directors,
American College of Emergency Physicians
“The future viability of our organization will
be dependent on our ability to deliver
Service Excellence.”
Mayo Clinic
“And importantly . . . A Commitment to
Excellence will not manifest without the
leadership, support and example set by
physicians.”
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©Jay Kaplan, M.D. & Studer Group 2013
Creating Physician Trust
If physicians don’t trust those that lead them,
they will, at best, become indifferent and
uninvolved in organizational efforts. More
likely, they will protest and resist efforts to
defend their differing agenda.
Caveat: Unhappy Physicians & Staff
Don’t Make for Happy Patients
If we can’t give our day a “10”, it’s
going to be awfully hard for our
patients to give their experience with
us and our day a “10”. . .
And no one is going to create
that “10” for us unless we
participate in the process.
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©Jay Kaplan, M.D. & Studer Group 2013
Where We Are
How We Need to Feel . . . What We Need to Do
Burnout and Satisfaction with Work-Life
Balance – Arch Int Med August 2012
Physicians who reported at
least 1 symptom of burnout
45.8%
Compared to gen population,
likelihood of burnout
increased 10.1%
Compared to gen population,
dissatisfaction with work-life
balance
increased 17%
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©Jay Kaplan, M.D. & Studer Group 2013
Emergency Medicine
Gen Internal Medicine
Family Medicine
Orthopedic Surgery
Ob/GYN
Mean
General Surgery
Int Medicine Subsp
Gen Surgery Subsp
General Pediatrics
Preventive Med/Occ Health
It’s Not Just Physicians . . .
Nursing Morale Survey 2007
Feel they are too busy to provide the
care they would like
Would recommend nursing as a
career
Would leave nursing if they could
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55%
49%
28%
©Jay Kaplan, M.D. & Studer Group 2013
A Plain Fact
Physicians are not trained for many of
the roles they are being asked to play in
today’s healthcare environment.
And even the role for which they were
trained . . . has changed.
The Different Roles Physicians Have
Craftsman: caring for the individual patient.
Team player: being a part of the team which
delivers that care in a coordinated and supportive
manner.
Manager: managing the process by which that
care is delivered.
Leader: creating the vision – getting everyone on
board.
For which role(s) did physicians receive training?
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©Jay Kaplan, M.D. & Studer Group 2013
Key Definitions
Engage
to attract and hold by influence or
power; to pledge oneself; to begin and
carry on an enterprise or activity
Align
to get or fall into line; to be in or come
into precise adjustment or correct
relative position
Path for Hospital/Practice Leaders
Create the Burning Platform
Connect Service and Quality
Define the Experience/Service Economy
Answer “What’s in it for me?”
(closer to now and to home)
What you can ask physicians to do for you
To improve the patient experience
To improve the team
To help themselves
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©Jay Kaplan, M.D. & Studer Group 2013
The Burning Platform
Declining Reimbursement
Workforce Shortage
Malpractice Risk
Transparency of Data
Pay for Performance – VBP
Quality and Service are Inseparabl3
Relationship between patient satisfaction,
complaints and lawsuits
Physicians with lower patient satisfaction results are more
likely to have patient complaints (RR 1.79;95% CI 1.38-2.33; p<.001)
Each one point decrement in patient satisfaction scores is
associated with a –
6% increase in complaints (RR 1.06, 95% CI 1.03 – 1.08;p<.0001)
5% increase in risk management episodes (RR 1.05, 95% CcI
1.01 – 1.09;p< .008)
Lower performing physicians were at greater risks for lawsuits
(RR = 2.10;p 95% CI 1.13 – 3.90; p<.019)
75% of complaints were related to communication issues
Stelfox HT, et al, The American Journal of Medicine 2005; 118: 1126 – 1133
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©Jay Kaplan, M.D. & Studer Group 2013
The Transparent Environment –
Quality On-Line
P4P: Value-Based Payment
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©Jay Kaplan, M.D. & Studer Group 2013
Service vs. Quality . . . or Service = Quality
Some Would Say . . .
Clinical Quality is the real deal,
the “hard stuff.”
Service Excellence is
the “fluff stuff.”
Communication = Compliance = Quality
Physician communication correlates STRONGLY
with adherence rates by patients in acute and
chronic disease. There are now over 100
observational and 20+ experimental studies
published demonstrating the correlation of
communication (patient satisfaction) with
compliance. Compliance with treatment regimens
has significant influence on quality measures in
chronic disease and outcomes.
Medical Care: August 2009 - Volume 47 - Issue 8
- pp 826
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©Jay Kaplan, M.D. & Studer Group 2013
British Medical Journal 2013
http://dx.doi.org/10.1136/bmjopen-2012-00157
Patient experience is positively associated with
clinical effectiveness and patient safety.
Associations appear consistent across a range of
disease areas, study designs, settings,
population groups and outcome measures
Positive associations
No association
Negative association
429 studies
127 studies
1 study
The Old Paradigm
Care
= Income
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©Jay Kaplan, M.D. & Studer Group 2013
The New Paradigm
Outcome = Income
Exceptional
Clinical Quality
&
=
Extraordinary Patient
Experience
$$$
Simple Truth #1:
We Live in a Service Economy
Our entire staff is
committed to your
complete
satisfaction and
empowered to
deliver
personalized
service to take care
of your needs.
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©Jay Kaplan, M.D. & Studer Group 2013
Key Words for Us
Satisfy
to please, to be adequate to an end in view,
to meet an obligation
Astonish
to strike with sudden and usually great
wonder or surprise
Memorable
worth remembering
Simple Truth #2:
We All Believe We Give Great Service
We assume
=
Patient
Satisfaction
=
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Employee
Satisfaction
©Jay Kaplan, M.D. & Studer Group 2013
Simple Truth #3: We think we’re doing
better than we actually are . . .
Wall Street Journal April 8, 2013
Doctors need to work on their people skills . . .
It’s something patients have grumbled about for a long
time . . . Doctors don’t listen. Doctors have no time . . .
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©Jay Kaplan, M.D. & Studer Group 2013
What is Excellent Physician Communication?
The physician listened (RR 1.8; 95% CI 1.0 – 2.5; p< .001)
The patient got as much medical information as they
wanted (RR 1.6;95% CI 1.1 – 1.9; p< .001)
The patient was told what to do if symptoms continued,
worsened or returned (RR 1.4; 95% CI 1.2 – 1.5; p<.001)
The patient spent as much time as they wanted with their
physician (RR 1.8; 95% CI 1.3-2.2;p<.001)
Keating NL, et al, Annals of Internal Medicine 2004; 164: 1016 – 1020
What Our Patients Get . . .
Physician Communication When Prescribing
(Arch of Internal Med, 2006)
Medications:
26% failed to mention the name of a new medication
13% failed to mention the purpose of the medication
65% failed to review adverse effects
66% failed to tell the patient duration of treatment
The Golden 2 Minutes
74% of patients are interrupted by providers when giving
their initial history in an average of 16.5 seconds
(J Gen Int Med, 2005)
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©Jay Kaplan, M.D. & Studer Group 2013
Simple Truth #4:
No Rest For The . . .
“If the other guy’s getting better,
then you’d better be getting
better faster than that other
guy’s getting better . . . or
you’re getting worse.”
-- Tom Peters
The Circle of Innovation
What Do We All Want?
•Care Quality for Our Patients  gives us peace
of mind
•Appreciation for What We Do  leads to loyalty
and retention
•Responsiveness to Our Issues  inspires
confidence in administration and we not us/them
•Efficiency of Our Practice  decreases the
frustration quotient, assists productivity
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©Jay Kaplan, M.D. & Studer Group 2013
Top Priorities for Meeting Physician Needs
Once Physicians are “Engaged” . . .
Tactics to Building Physician Trust
1. Include physicians in strategic planning
2. Create ongoing communication vehicles
3. Diagnose physician sentiment
4. Develop a physician satisfaction team
5. Round on physicians
6. Facilitate physician/nurse communication
7. Increase physician appreciation/recognition
8. Give physicians training to help them be
successful
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©Jay Kaplan, M.D. & Studer Group 2013
Tactic #1: Include Physicians in Strategic
Planning and Goal Setting
Strategic planning is setting the course for the
future
Defining an overarching vision
Identifying strategies and actions to execute the
vision
Setting goals
Allocation of resources
Guidelines
Include physician leaders that are reasonably
well aligned
Promote clinical excellence and patientcentered care as the shared agenda
Physicians involved in strategic planning
become the communication vessel to other
key stake holders
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©Jay Kaplan, M.D. & Studer Group 2013
Tactic #2: Committed Ongoing Communication
Between Senior Leaders & Physicians
Regular meetings with medical staff and senior
hospital leadership
Regular agenda item at MEC/Dept. meetings
Annual retreat with physicians, board members,
senior management
New physician breakfasts
Conduct small physician “focus groups” on
possible strategic initiatives
Develop a “physician counsel” (PAG) to provide
direct access and advice to the CEO
Tactic #3: Survey Your Physicians
Guidelines
Make it easy and simple
Contact key physician opinion leaders to
communicate the survey
Incentivize
Share “plan of action” regarding results
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©Jay Kaplan, M.D. & Studer Group 2013
Keep It Simple
1. What are the 3 things which you most love
about practicing medicine in this
environment?
2. What are the 3 things which you most
dislike about your current practice?
3. What suggestions/solutions do you have
for those issues mentioned in #2?
What Are The Issues?
Hospital Practice
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©Jay Kaplan, M.D. & Studer Group 2013
More on Hospital Practice Issues…
Tactic #4: Develop a Physician Satisfaction
Team
Goal: Improve Physician Satisfaction
Tasked to create visible response to physician
issues
Reports to CEO
Accountable to improve physician satisfaction
Invite physician membership
Empower to act quickly and decisively
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©Jay Kaplan, M.D. & Studer Group 2013
Physician Satisfaction Action Plan
Communication
is Crucial . . .
Physician
Leadership
to Group
You asked.
We responded.
•Additional Clinical Review
Stations Located on Medical and
Surgical Floor.
•Computers in Waiting Areas for
patient/visitor use
•Additional Nursing Staff Hired.
Medical Department RN Staffing
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©Jay Kaplan, M.D. & Studer Group 2013
Tactic #5: Set Standard Expectations for
Rounding on Physicians/Stoplight Report
WHY: Establishes sincere communication
between leadership and physicians
WHO: Senior leaders, Physician Leaders,
Administrative directors
WHEN: Schedule a time at physician’s convenience
HOW: “One on one”, with a rounding log
Who is doing a great job?
What is going well? What is not working for you?
Do you have the tools/equipment you need?
Anything you need for me to do for you right now?
3 Steps
“Do you have everything you need to provide
excellent care to your patients?”
“I want to be responsive….Let me update you
since we last talked…”
As a reminder our current focus on quality/the
patient experience/teamwork is . . . I am asking all
of the medical staff to . . . (wash hands, sit down,
round collaboratively)
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©Jay Kaplan, M.D. & Studer Group 2013
Physician Rounding Summary Log –
Longitudinal by Physician
Physician Rounding Pocket Card - sample
Wins
Efficiency
Care Quality
Appreciation
Responsiveness
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©Jay Kaplan, M.D. & Studer Group 2013
Document What You Are Doing Stoplight Report
Tactic #6: Help Physicians Practice
Recommend and Set Expectations for the
Implementation of Tools to Improve
Communication
5 Physician Wow’s
Got Chart
Bedside Questions for Your Physician
Patient Visit Guide
Physician Preference Card
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©Jay Kaplan, M.D. & Studer Group 2013
The 5 Physician Wow’s
Telephone log
Having information available when calling
or returning calls to physicians
Patient locator log
Having open computers for physician
documentation
At least one thank-you card sent weekly
to a physician
Got Chart

Date:
Before you call, did you:
Ensure you are calling the appropriate physician (primary, consulting?)
Check: Are there standing orders to cover this situation?
Review physician preferences for when and where to call?
Check: Does anyone else need the physician?
See and assess this patient yourself?
Read the most recent MD progress notes and notes from the nurse
who worked the prior shift?

When you call:
Have at hand: Chart, Recent Assessment (current and past lab results
with times tests done), lists of meds, code status and most recent vital
signs.
Enter the complete 7-digit phone number when paging.
Identify yourself, the unit, the patient, room number, and the diagnosis.
Be clear about the reason for the call.
Document whom you spoke to, time of call, and summary of
conversation.
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©Jay Kaplan, M.D. & Studer Group 2013
Physician Note Pad
Dear Doctor:
•My diagnosis?
•Tests for today
•New medications?
•Requirements for going
home?
•Other questions?
Patient Visit Guide
We are committed to
providing you with
excellent care
Recommendations/
Instructions
Follow Up Care
What is the primary
reason for your visit
today?
Post-Visit Care – How
will I learn about my test
results
What is the one thing we
need to focus on to
assure an excellent
visit?
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©Jay Kaplan, M.D. & Studer Group 2013
Physician Preference Card
Dr. Betty Harrison
Specialty: Family Practice
What 3 items from a nursing perspective do you consider most important
in the care of your patients?
1. Accurate and complete understanding of patient’s clinical statistics, vital
signs, current labs, and graphic chart at the time of any phone call.
2. Complete and accurate record of home medications and allergies.
3. Address orders accurately and in a timely manner.
What items would you like to have improved?
 Nursing staff should have more complete working knowledge of patient’s
admitting diagnosis, care tract, medications, allergies and pertinent labs.
 When nurse pages me, he/she should be available when I call back and have
graphic chart with updated vital signs, I & Os, as well as patient’s chart with
updated labs and other test results if pertinent.
Taking You and Your Organization to the Next Level
© 2012 Studer Group®
Tactic #7: Physician Recognition
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©Jay Kaplan, M.D. & Studer Group 2013
Organizational Acknowledgement
Tactic #8: Sponsorship and Support for
Physician Training
Physician Leadership Academy
Defined Physician Champions
General Medical Staff Education
Shadow Rounding with Individual Physicians
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©Jay Kaplan, M.D. & Studer Group 2013
Self –Test for Physicians/APP’s
1.
Do you acknowledge and make physical contact with the
patient and others in the room when you first enter?
2. Do you introduce yourself and share your experience and
commitment? Do you manage up the rest of the team?
3. Do you sit down at the patient’s bedside?
4. Do you give the patient and family 2 minutes to tell their
story?
5. When you get up to perform the physical examination, do
you tell the patient? Do you articulate your findings?
6. Do you explain to patients/families what you have found
and the meaning of their diagnostic and therapeutic
results?
7. Do you explain to patients/families the expected duration
of the illness, diagnostic work-up, or healing process?
8. Are you using key words to convey to patients your
commitment to their comfort and safety?
9. Are you collaboratively rounding on patients with the
nurse in the room as a vital team member?
10 If a patient hand-off is required, are you managing up the
. oncoming provider? And whenever possible doing the
hand-off at the bedside?
11 Are you completing the patient visit with “What questions
. do you have for me? Is there anything you would like for
me to go over again?
12 Are you closing the patient encounter with a statement of
. gratitude and/or appreciating the patient?
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What You Can Ask Physicians to Do
to Help You
For Our Patients
Sit down and use key words
Touch all the bases in communication
Collaborative Rounding
Follow up phone calls
For Our Staff
Colleague as Customer/Partner
Collaborate/Appreciate/Respect/Educate
Say “Thank You” more
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©Jay Kaplan, M.D. & Studer Group 2013
Summary
“Physicians go where they are welcomed, remain
where they are respected and grow where they
are nurtured.”
Bill Leaver, CEO Iowa Health Systems
Bill Leaver
CEO, Trinity Health Systems
Thank you.
No one said it was
Jay Kaplan MD, FACEP
going to be easy . . .
[email protected]
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©Jay Kaplan, M.D. & Studer Group 2013