Physician Leader: Culture Critical to Achieving Health System Goals

Wenderoth recently talked with HealthLeaders about a range of issues such as physician enterprise, quality improvement, and patient safety. Following is a lightly edited transcript of that conversation.

HealthLeaders: What are the primary elements of being a successful physician enterprise leader?

Suzanne Wenderoth: At the most basic level, physician enterprise leadership is about establishing a common cultural foundation. You need to establish a common mission, principles, and values. You need to let individual physicians know—regardless of where they work—that we are all aligned toward the same goals.

Another piece is that it is not only the physician component of the enterprise. It is important that we identify and align our goals with the other legs of the stool, including nursing and operations. We must establish coordination together.

Fundamentally, you must achieve aligned goals; and, often, physicians measure that through compensation. So, whether it is shared savings arrangements or other incentives, you must be able to deliver not only on the mission but also on the compensation.

Finally, one goal for physician enterprise leadership is to alleviate some of the physician frustrations. Whether it is with the electronic medical record or complex processes—alleviating frustrations is a critical part of the journey as well.

HL: Give a specific example of unifying physicians under one mission or culture.

Wenderoth: If you think about always putting the patient at the center of what you do, that is a simple value to remember. It also aligns us. If we pick any of our individual goals on a scorecard, if you always look at it from the patient-centered perspective, that is an example of a core value.

If you think about the mission as being patient-centered, you can take any one of your measures such as falls prevention and look at it from the patient perspective. You do not want to prevent patients from getting out of bed; rather, you can provide them with assistive devices and use remote monitoring to help them be mobile in a safe way.

HL: What are the primary elements of physician alignment?

Wenderoth: It is tricky because you need to know what you are aligning to. You need to align physicians and the health system, but you also need to align physicians and compensation.

No. 1, you need to match people’s expectations with the strategy and the goals. Then you must share data transparently and ask physicians for their insights. You also need to match incentives to what is being reimbursed. We all have lots of great ideas in medicine, but if incentives are not matched with how we are being paid, that creates misalignment.

HL: What are the primary components of successful quality initiatives?

Wenderoth: The most important piece is to go to the frontline, which is where the work is really happening. You need to have those folks identify the most critical issues.

Then, you must have a fixed goal. It could be aspirational, and you might be concerned that you will not hit it, but that’s OK. You must have a set goal, with a finite number or metric in mind. The goal also must come with a deadline or timeline. Then, as you design activities and measure improvement, you must give feedback in a regular fashion, with a cadence so that people can react to it.

You want to create standard processes that people can predict and anticipate.

HL: What are the primary components of successful patient safety initiatives?

Wenderoth: Here at Tower Health, we embody and embrace just culture. The idea is that humans are fallible. We are all going to make mistakes, but we need to be willing to talk about our near misses and our errors. As a culture, we need to be willing to address near misses and errors while not being shamed by them or embarrassed. Then, we need to be preoccupied with fixing problems.

You need to have an effective incident reporting system. We have a reporting system called RL Solutions that is quite transparent and nonpunitive.

A few years ago, we did not have nearly as many safety reports being placed as one would have expected or hoped. Since reporting is foundational to patient safety, it is important that you get enough people reporting. We realized that there were so many steps to the reporting process that we were creating a barrier for our employees. So, we initiated a process improvement effort and cut the number of reporting steps in half, and our reporting numbers went way up.

Another key to success in patient safety is building policies and processes that address errors. Without guiderails, people will continue to make errors.

Lastly, you need proactive education. You must tell friends and colleagues what you have learned, so everyone can capitalize on the knowledge.

HL: How can health systems and hospitals move toward zero harm in patient safety?

Wenderoth: So much of this is culture. Every healthcare worker must decide that patient safety is a fundamental component of how they will do their work throughout the day.

At Tower Health, we have taken a serious approach to change management. It is one thing to say you want to engage in change, but it is another thing to focus on the science of change management. You need to look at the number of people who are necessary to move change, and you must figure out how you are going to move culture. Changing culture is the first step to achieving zero harm.

Another factor is having an optimal learning system, so you can mine data and understand what your trends look like.

Then you must look at designing care improvement. One area that will be exciting in coming years is around engaging patients. The co-design of care can move you to high reliability and zero harm. You must have patient experience, patient committees, and patient voice in the co-design of care.