Care coordination among PCPs, hospitalists and ED physicians is a challenge for most hospitals. Recently, the medical leadership of two health system hospitals decided to tackle this problem by using HSG’s approach to building a shared vision.
This approach had been used by HSG to develop a shared vision within established groups and advocated in several recent HSG Physician Strategy News articles ( Creating a Shared Vision for Your Network and Capitalizing on your Group Vision ) and HSG webinars ( Building a Strategic Vision for Your Employed Physician Network and Creating a Shared Vision with Your Physician Network ). These offerings extolled the virtues and applicability of developing a shared vision to drive strategy, implement change, engage physicians, and establish a common culture. While an underlying presumption is that the approach would be utilized with established groups – such as employed provider groups and organized medical staffs – this client applied the concept and associated processes to form a group to tackle patient care issues the three disparate specialties shared.
The Chief Medical Officer (CMO) of the two closely associated and jointly led hospitals that are part of a seven-hospital regional system recognized the need to better coordinate and align the services provided by the emergency medicine, hospital medicine, and primary care specialties. Collectively, these specialties accounted for most of the hospitals’ primary contacts with its patient population and represented significant opportunities to enhance safer, more seamless transitions of care. The CMO desired to create a “virtual” multi-specialty group of the three specialties to address mutual issues.
Each of the targeted specialties are represented in separate, formal medical staff departments, linked only by the Medical Executive Committee. The only cross-departmental activity is informal conversations between the department chairs. The target specialties represent a mix of employed (hospital medicine and primary care), independent (primary care), and exclusively contracted (emergency medicine) physicians. Both the emergency medicine and hospital medicine services consistently and significantly rely on part-time physician coverage, though each is making in-roads toward more full-time staffing.
The CMO and the Director of Primary Care championed the initiative. Two different approaches were discussed to achieve their desired result. One approach would first create the vision and strategies for the envisioned group, with leadership council development to follow. The alternate approach would first create a leadership council that would then develop the vision and strategies. The champions decided to develop the vision and strategies first. Significantly, the hospitals’ CEO changed in the middle of the project and the new CEO became intimately involved in the project, which boosted the group’s credibility, viability, and efficiency.
The project started with interviews of the most “active” physicians in the target specialties, using a customized, preapproved interview guide. The interviews revealed physicians’ perceptions of the strengths and opportunities of the specialties’ interactions and the transitions of care processes. In addition to informing the vision and strategies work, the interviews also elicited a number issues for the new group to address and potential metrics by which process improvement could be gauged.
A Steering Committee consisting of key members and administrative leaders of the three specialties and hospital administration was created and convened. The first meeting reviewed the project’s background and intended course, presented interview impressions and introduced potential shared vision elements. The second meeting reviewed and revised a draft shared vision statement. The third meeting “finalized” the vision statement and intended to introduce potential strategies to achieve their vision. While developing the potential strategies (actionable), certain vision elements seemed ideally suited for “guiding principles” to steer thought processes and future actions. The guiding principles addressed concepts such as keeping patients at the center of the decision-making process, while openly, honestly and respectfully discussing issues in a manner that builds trust and understanding.
After the third Steering Committee meeting, the project champions and Steering Committee members presented the project background and the draft vision statement to their peers during an all-provider meeting of the three specialties. During the meeting, small group discussions verified the shared vision’s validity and launched opinions of how it could be accomplished. The meeting’s mood was very positive and focused on future success rather than impending barriers.
During the Steering Committee’s fourth and final meeting, the vision, guiding principles and strategies were finalized, and the new Leadership Council was established. The Charter and membership expectation documents for the Leadership Council were developed with the champions and CEO prior to the meeting, anticipating the transition of the Steering Committee into the Leadership Council – a predetermined event intended to maximize corporate knowledge and group momentum.
The Steering Committee members were very engaged throughout the project. The physicians indicated that they had previously focused exclusively on their own perspectives and essentially discounted others’. They expressed a greater understanding of others’ viewpoints and an appreciation for the impact actions had on other specialties.
The project created a solid foundation upon which to build cooperative efforts addressing mutual patient care issues. The vision and guiding principles hold the promise of promoting positive change, expanding physician engagement in effecting that change, and driving enhanced professional understanding leading to a more homogeneous culture.
