As the financial viability of hospitals and health systems increasingly depends on metrics tracked by programs like the Centers for Medicare and Medicaid Services (CMS)’s quality program, it is more and more important to engage provider teams in the improvement of these metrics. Since many performance tracking programs are relatively new, it can be challenging to engage established providers who feel that they should be focusing on patient care and patient care only. This is especially true for physicians who have been out of medical school for more than 5-8 years. When these providers started their practice, most CMS measures were either not around or were still being developed.
I find that the key to shifting mindsets around quality and efficiency metrics is as simple as engaging the physician team, aligning the team around a united practice culture and mission, and developing a thoughtful incentive plan. In this post, I outline key ways our team shifts mindsets on quality and efficiency metrics to create a high-functioning emergency department team working toward shared goals.
Lay a Groundwork of Trust and Transparency
Dictating metric goals without building a relationship with the team you are relying on to achieve metric improvements is a futile effort. The best way to shift mindsets is to take the time to fully understand the team’s current mindset. In other words, LISTEN. We find it usually takes two to three months to build a relationship with a team. During this time, it is important not to make any major changes. Forget strategy and focus on listening and understanding the unique challenges the practice faces. It is also important to not only focus on working with the physicians and APPs, but also the nurses, techs, and administrative employees. Everyone plays a critical role in the culture and efficiency of the department.
The best way to do this is to work with the team in the trenches. Being a practicing physician makes me a much more effective clinical leader and emergency department consultant because I understand the pressures and realities working providers face. Team members respect leaders who do what they say they are going to do, even when challenged by the realities of working clinically.
Align your Team Around Culture First, Not Metrics
It can be tempting to dive immediately into hard-hitting strategies to improve quality and efficiency. However, these strategies will fall flat if your team does not trust you and feel connected to the mission, vision, and values you set forth for the department. Before you set goals, define your overall expectations for the culture of the team. Talk with each member of the team and ensure they believe in your mission and vision. If you need inspiration for your team’s core values, consider these six philosophies forward-thinking emergency departments share. These philosophies are the cornerstone of every high-functioning ED team we have encountered.
Communicate the Necessity and the Urgency
Once you build trust with your team and are aligned on your vision, mission, and values, you are in a position to communicate the necessity and urgency of improving performance metrics at your hospital. When the team knows that what you are communicating benefits them as much as it benefits the hospital or health system, the conversation feels less like orders or criticism and more like what it is: a genuine reality that impacts the viability and longevity of both the hospital and the provider’s career. Being completely transparent about the financial implications of the measures is a great place to start. It is also important to keep your provider teams up-to-date on the way the healthcare industry is evolving so that the motivation behind things like patient satisfaction scores and CMS quality measures is clearer.
Set Measurable Goals and Make a Plan with a Timeline
Once your team trusts you, believes in your facility’s mission and vision and core values, and understands the necessity and impact of the metrics they are held accountable to, you are in a position to set goals and build a strategy that has legs. For optimal positive impact, I suggest engaging your clinical team as much as possible in goal setting and strategic planning. This can be achieved by including them in more departmental and interdepartmental meetings and always keeping them up-to-date with communications with hospital administration. A team that is engaged in the planning will be more engaged in the operational execution of the plan. Ensure the entire team is aware of the goals you have set, the strategy behind them, and your operational plan to achieve them. It is crucial to apply a timeline to your strategy and to keep the entire team up-to-date on your progress implementing the plan and achieving the goals.
Focus on Metrics Providers Can Control
When working with emergency department teams, a common complaint is that providers are being measured by metrics that they do not have full control over. It is true, an emergency department physician does not have control over the whole care environment like a family practice physician who works in a clinic might. However, there are some metrics that ED providers have significant control over, and these are the metrics we focus on. Examples include: Bed-to-provider times, provider-to disposition times, nurse-physician communication (which impacts patient experience greatly), and sepsis and stroke care times. When it comes to patient satisfaction scores we zero in on tracking the specific Press Ganey questions that can be impacted directly by providers (i.e. “Did the provider explain everything about your care?”). Providers who feel that they are measured by metrics they can directly impact are much more engaged than providers who feel they are measured by nebulous metrics influenced by factors mostly outside their control.
Give Providers Skin in the Game
That brings me to my final, and perhaps most influential strategy for shifting mindsets on quality and efficiency metrics: giving the provider team equity in their practice. When we develop goals for the department for metric improvement, we also create an agreement with the hospital to tie a portion of provider income to the metrics we are working to improve. Implementing a thoughtful incentive plan spurs significant improvements in provider engagement because providers feel a greater sense of ownership in their practice. It not only improves metrics but also reduces provider turnover and burnout.
Shifting mindsets to create a high-functioning emergency department team is about much more than setting metric goals. In fact, that is a very small part of the effort. Most of the meaningful and effective work is listening, aligning your team around a shared mission, educating your team on the importance of the metrics, and engaging the team in setting goals and creating a strategy to improve performance.