The Role of the Physician Leader in Emergency Medicine
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1 The Role of the Physician Leader in Emergency Medicine Jay Kaplan, MD, FACEP Practicing Clinician and Director, Service/Operational Excellence, CEP America Board of Directors, American College of Emergency Physicians Medical Director, Studer Group Caveat #1: What Brought Us to this Dance... Ain t Going to Get Us to the Next One Jay Kaplan, M.D 2013
2 Caveat #2 The Best Definition of Madness is To keep doing things the same way and expect different results... Caveat #3 How Most of Us Approach Change 2 Jay Kaplan, M.D 2013
3 Caveat #4: To Get Quality Anything... Double Vision is Required Systems People Process Outcomes Staff Patients Physicians Which Means... Efficient Care/Flow Transitions of Care Staff Engagement Patient Engagement Alignment of Behaviors 3 Jay Kaplan, M.D 2013
4 Caveat #5: It s About The Team While we give care seemingly individually, The Patient and Family Experience is dependent upon the coordinated actions of all members of the team... From the moment they walk in, to the moment they walk out or on... Success is never achieved alone. If it s not always... It s not great... Caveat #6: 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 4 Jay Kaplan, M.D 2013
5 Where We Are How We Need to Feel... What We Need to Do The Big Question How can you, as a department, create a consistent high quality compassionate experience for your patients, despite: Staff Diversity Different approaches/training Different years of experience Different and rotating personnel The pressures for doing more with less Time Time Time???? 5 Jay Kaplan, M.D 2013
6 If it is about Always, What is Required Consistency of Practice Dependability of Performance Uniformity of Behavior And yet... Variation in Clinical Practice is Rampant Head CT examinations were ordered in 8.9% of emergency department visits Two-fold variation in overall head CT ordering ( %), Three-fold variation in head CT ordering for atraumatic headache ( %). The American Journal of Medicine (2012) 125, Jay Kaplan, M.D 2013
7 Can We Change the SOP from...? I m going to do it my way. to We re going to do it our way. A Few Lessons Learned Blame Nobody, Expect Nothing, Do Something (Bill Parcells, NY Post 1999) Change starts at home first me, then thee (Leadership) It s not the ideas, it s the implementation (Accountability) Perception is all there is (Almost) 7 Jay Kaplan, M.D 2013
8 The Roles We Must Play... Every Day Define the Vision and Get Everyone on Board (Leader) Help Create a Great Practice Environment - Fix the Systems (Manager) Engage Your Staff and Providers - Create The Team (Team Player) Ensure Consistent Clinical Quality and Compassion (Healer) How To Lead: Steps In The Process Define your vision Engage your people (Leader Rounding/Stoplight Report) Clarify your expectations (Standards/ICARE/AIDET) Give them credible feedback Teach them the skills (Skills Sessions) Verify their compliance (Rounding on Patients/Shadow Rounding with Providers) Reward or Replace (There Must Be Consequences) 8 Jay Kaplan, M.D 2013
9 Where To Start: Define a Common Destination If you don t know where you are going, you might wind up someplace else. Ask Yourself and Then Your Staff: What Do You Want to Be Known For? 1. I am known for (1-2 items); by next year at this time, I plan also to be known for (1 additional item): 2. We (My practice) is known for (1-2 items); by next year at this time, we plan also to be known for (1 additional item): 3. The first step I (we) need to take in order to make that happen is The single biggest obstacle we have to overcome is... 9 Jay Kaplan, M.D 2013
10 Have the Conversation: What Do We Want To Be Known For? Our Most Difficult Task Our: Philosophy Goals Passion Commitment must be shared by everyone Jay Kaplan, M.D 2013
11 Engage Your People: Leader Rounding Harvest Wins: Are there any individuals or physicians you would like me to compliment or recognize? Focus on the Positive: What is going well today? Identify Process Improvement Areas: What systems can be working better? Repair and Monitor Systems Do you have the tools and equipment to do your job? Coach on Behavior/Performance Standards Our focus for the day is. Can you do that? Rounding on Physicians Simplified - 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) 11 Jay Kaplan, M.D 2013
12 Physician Rounding Summary Log Longitudinal by Physician Physician Rounding Pocket Card Wins Efficiency Care Quality Appreciation Responsiveness 12 Jay Kaplan, M.D 2013
13 Fix the Systems - Create a Working List What is working... What is not working... Are there tools/equipment you need? Are there personnel you need? Is everyone on board? Key Tactic: Document What You Are Doing - Stoplight Report Green : Here is what we have already done. Yellow: Here is what is in process. Red: We can t do now and here is why. 13 Jay Kaplan, M.D 2013
14 Clarify Your Expectations: Standards We think we re doing better than we actually are Jay Kaplan, M.D 2013
15 Give Them Their Data (Physician Questions Based on patients seen 7/1/13 to 10/31/13 ) Give Them Their Data 5. Treats ED staff in a professional and courteous manner 6. Effectively communicates patient differential dxs/treatment plan to nurses 7. Explains the problem and treatment to patient 9. and/or Is able family to satisfactorily remain calm 8. Is easily under approachable stress and with is questions, able to problems and/or suggestions by staff handle crises well 9. Is able to remain calm under stress and is able to handle crises well 15 Jay Kaplan, M.D 2013
16 No Excuses Teach Them the Skills For the Patient: Sit Down at the bedside Use Key Words Use the 5 Fundamentals of Communication (AIDET ) Collaborative Rounding For Staff Colleague as customer Say Thank You more 10-5 Rule 16 Jay Kaplan, M.D 2013
17 Self Test for Physicians Self Test for Physicians 17 Jay Kaplan, M.D 2013
18 Verifying Behaviors: Leader Rounding on Patients Good morning. My name is. I am medical/nursing director of. I am just stopping by because we put our patients First, and our goal is to give you exceptional care. Would you be willing to share your experience in the hospital with me? Shadow Rounding with Physicians/APP s Behaviors Observed: Patient #1 Patient #2 Patient #3 ICARE skills: Introduce/Inspire Confidence Did you state your name and your role? Did you highlight Connect your skill and expertise and Comments Comments Comment that of your health care team? Connect Did you connect with the Did you connect with the and the family? Did you make eye patient contact, shake hands and or the family? make physical contact? Any non-medical connection? Did you sit down at the bedside? Did you make eye contact, shake hands or make physical contact? Any non-medical connection? Did you sit down at the bedside? Acknowledge Did you give the patient/family uninterrupted time to tell their story? Did you articulate what you were told and findings during your physical exam? Review Did you review what you thought was going on with the patient? Did you explain what tests and procedures you were going to do? Did you estimate how long the process would take (under-promise and over-deliver)? Educate Did you explain home care and what to expect? Did you ask What questions do you have? Is there anything else I can do for you? Did you close the encounter and thank the patient for the privilege of caring for them? Recommendations: Coaching Other Skills: Rounding Follow-up Phone Calls Teamwork 18 Jay Kaplan, M.D 2013
19 Accountability - Rounding at 11 a.m. Whiteboards Filled Out? 19 Jay Kaplan, M.D 2013
20 White Board Audit Key Tactic: On or Off the Bus Being Transparent 20 Jay Kaplan, M.D 2013
21 21 Jay Kaplan, M.D 2013
22 Do You Have Any Franchise Players? Do You Have Any Vampires? 22 Jay Kaplan, M.D 2013
23 Which Works Better? The Carrot or The Stick The Work Environment Compliment to Criticism Ratio 3 to Positive! 2 to Neutral 1 to Negative Source: Tom Connellan, Inside the Magic Kingdom, pages Jay Kaplan, M.D 2013
24 Say Thank You More The Simplest Recognition: Saying Thank you at the end of the day (shift) What Happens If People Don t Get On Board? If you permit it, you promote it What you can do is to not permit it 24 Jay Kaplan, M.D 2013
25 Crucial Communications May I Speak Freely? My purpose in talking with you is (a mutual goal) When you I feel... (action you are giving feedback on something they can change) I imagine that (positive intent/benefit of the doubt) And because we both want (common goal) I need (specific alternative behavior requested) Affirm him or her as a person Summary We live in an experience economy. Satisfy is not enough. If the other guy s getting better... Quality gets you in the game. Service helps you win. 25 Jay Kaplan, M.D 2013
26 No one said it was going to be easy... Thank you. Jay Kaplan MD, FACEP 26 Jay Kaplan, M.D 2013
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